Cardiology Department, Rabin Medical Center (Beilinson and Hasharon Hospitals), Petach-Tikva, Israel and the "Sackler" Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Catheter Cardiovasc Interv. 2018 Oct 1;92(4):E262-E270. doi: 10.1002/ccd.27375. Epub 2017 Oct 13.
The last decade, regarded as the DES era in PCI, has witnessed significant advances in the management of coronary disease. We aimed to assess temporal trends in the practice and outcome of percutaneous coronary intervention (PCI) during the drug eluting stent (DES) era.
We analyzed 18,641 consecutive PCI's performed between January 2004 and December 2016, distinguished by procedural date (Q : 2004-2006, n = 4,865; Q : 2007-2009, n = 4,977; Q : 2010-2012, n = 4,230; Q : 2013-2016, n = 4,569).
At presentation, mean patients age was 65 (±11) years and 22.8% were females. Over time, there was a rise in the relative number of octogenarians (Q : 10.7% vs Q : 15.5%, P < 0.001) and an increase in the burden of most comorbidities (e.g., left ventricular dysfunction ≥ moderate and chronic kidney disease, P < 0.001 for both). Despite a 2-fold increase in the rate of complex interventions, and a 3-fold increase in the rate of unprotected left-main angioplasty (P < 0.001 for both), the radial approach was increasingly adopted (Q : 2% to Q : 63.5%, P < 0.001). DES implantation increased from 43% to 83% at the expense of bare metal stent (BMS) application, and accompanied by drug coated balloon sprout to 1.8%, P < 0.001. Kaplan-Meier survival curves revealed a time-based enhanced outcome, with a decreased rate of death, MI, target vessel revascularization and CABG over the years.
In the last decade, PCI has evolved to offer better outcome to more elderly, sicker patient population, with more complex coronary disease interventions. The shift to second generation DES and to enhanced PCI techniques may explain part of this progress.
在经皮冠状动脉介入治疗（PCI）的药物洗脱支架（DES）时代的过去十年中，冠心病的治疗取得了显著进展。我们旨在评估 DES 时代 PCI 实践和结果的时间趋势。
我们分析了 2004 年 1 月至 2016 年 12 月期间连续进行的 18641 例 PCI，按手术日期区分（Q1：2004-2006 年，n=4865；Q2：2007-2009 年，n=4977；Q3：2010-2012 年，n=4230；Q4：2013-2016 年，n=4569）。
在就诊时，患者平均年龄为 65（±11）岁，22.8%为女性。随着时间的推移，80 岁以上患者的相对数量有所增加（Q1：10.7%至 Q4：15.5%，P<0.001），大多数合并症的负担也有所增加（例如，左心室功能障碍≥中度和慢性肾脏病，两者均 P<0.001）。尽管复杂介入治疗的比例增加了一倍，且无保护左主干血管成形术的比例增加了三倍（两者均 P<0.001），但桡动脉入路的应用越来越多（Q1：2%至 Q4：63.5%，P<0.001）。DES 的植入率从 43%增加到 83%，而裸金属支架（BMS）的应用则相应减少，同时药物涂层球囊的应用也增加到 1.8%，P<0.001。Kaplan-Meier 生存曲线显示，随着时间的推移，死亡率、心肌梗死、靶血管血运重建和 CABG 的发生率逐渐降低，患者预后得到改善。
在过去的十年中，PCI 技术不断发展，为更多老年、病情更严重的患者提供了更好的治疗效果，针对更复杂的冠状动脉疾病的介入治疗也有所增加。第二代 DES 的应用和增强型 PCI 技术的应用可能是这一进步的部分原因。
