Chung Matthew J, Hansen Jonathan D, Schulteis Ryan D, Boggan Joel C, Jones W Schuyler, Povsic Thomas J, Roberts Susan, Krucoff Mitchell W, Rao Sunil V
Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA.
Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Cardiovasc Revasc Med. 2017 Dec;18(8):588-591. doi: 10.1016/j.carrev.2017.05.004. Epub 2017 May 8.
We sought to characterize how the perceived risk of early dual antiplatelet therapy (DAPT) discontinuation is incorporated into operator decision-making regarding stent choice, using a simple pre-procedure survey screening for clinical variables that may lead to early DAPT discontinuation.
Understanding which factors influence operator decision-making regarding stent choice during percutaneous coronary intervention (PCI) could help identify areas for quality improvement.
We retrospectively identified 1202 patients who underwent PCI from July 2008 to January 2013 at the Durham Veterans Affairs Medical Center. We excluded patients without a complete pre-procedure survey within 14days of PCI, repeat procedures on the same patient and those who received both drug-eluting stents (DES) and bare-metal stents (BMS) or no stent during PCI, leaving 864 patients. The primary outcome was the independent association of "yes" responses to survey items with the odds of DES use during PCI.
Of 864 patients, 661 received DES and 203 received BMS. A "yes" response to "planned major surgery or dental work in the next year" (OR 0.20, 95% CI 0.11-0.36, p<0.001), "recent bleeding event or bleeding diathesis" (OR 0.31, 95% CI 0.14-0.68, p=0.003) or "currently taking Coumadin" (OR 0.39, 95% CI 0.19-0.78, p=0.007) was independently associated with lower odds of DES use.
Responses to 3 items on a simple pre-procedure survey screening for clinical variables that may lead to early DAPT discontinuation were independently associated with stent type used during PCI, suggesting the importance of these factors in an operator's stent choice.
我们试图通过一项简单的术前调查筛查可能导致早期双联抗血小板治疗（DAPT）中断的临床变量，来描述早期DAPT中断的感知风险是如何纳入术者关于支架选择的决策过程中的。
了解哪些因素影响经皮冠状动脉介入治疗（PCI）期间术者关于支架选择的决策，有助于确定质量改进的领域。
我们回顾性确定了2008年7月至2013年1月在达勒姆退伍军人事务医疗中心接受PCI的1202例患者。我们排除了PCI术后14天内未完成完整术前调查的患者、同一患者的重复手术患者以及PCI期间接受药物洗脱支架（DES）和裸金属支架（BMS）或未接受支架的患者，最终纳入864例患者。主要结局是对调查项目的“是”回答与PCI期间使用DES几率的独立关联。
864例患者中，661例接受了DES，203例接受了BMS。对“计划在明年进行大手术或牙科治疗”（比值比[OR]0.20，95%置信区间[CI]0.11 - 0.36，p<0.001）、“近期出血事件或出血素质”（OR 0.31，95% CI 0.14 - 0.68，p = 0.003）或“目前正在服用华法林”（OR 0.39，95% CI 0.19 - 0.78，p = 0.007）的“是”回答与使用DES的较低几率独立相关。
对一项简单的术前调查中关于可能导致早期DAPT中断的临床变量的3个项目的回答，与PCI期间使用的支架类型独立相关，表明这些因素在术者支架选择中的重要性。
