2017 年更新版与 2012 年适宜性使用标准相比，非急性冠状动脉综合征患者冠状动脉血运重建的适宜性比较。
Comparison of coronary revascularization appropriateness for non-acute coronary syndrome cases under the 2017 update vs the 2012 appropriate use criteria.
机构信息
MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia.
MedStar Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia.
出版信息
Catheter Cardiovasc Interv. 2019 Mar 1;93(4):620-625. doi: 10.1002/ccd.27895. Epub 2018 Oct 2.
OBJECTIVES
To compare coronary revascularization appropriateness for non-acute coronary syndrome cases under the 2017 update vs the 2012 appropriate use criteria (AUC).
BACKGROUND
In 2017, the 2012 AUC for coronary revascularization were updated. We examined how applying these new 2017 updates to our previous inappropriate cases would change their appropriateness.
METHODS
We identified 50 cases of patients who underwent coronary revascularization for stable ischemic heart disease who were deemed inappropriate under the 2012 AUC. Two separate physicians reviewed the cases and applied a new AUC based on the 2017 AUC. Next, if there was a change, the reason was identified.
RESULTS
Average age was 64, majority being male (29; 58%). Forty-two (84%) were asymptomatic upon presentation. Most cases (27, 54%) dealt with percutaneous coronary intervention (PCI) of the right coronary artery. After applying the 2017 AUC, 34 of the 50 inappropriate failures (68%) would be changed from "inappropriate" to "may be appropriate care." Of the 34 cases, 25 (73.5%) were changed due to the new AUC no longer expecting the patient to be on ≥2 anti-angina medications prior to PCI. Of the 34 cases, eight (23.5%) were changed due to the new AUC expanding the use of non-invasive modalities.
CONCLUSIONS
Applying the 2017 AUC led to a statistically higher number of cases being deemed "may be appropriate." The most common cause for the change included the change in requirement for anti-angina regimen and the expanded role of non-invasive modalities.
目的
比较 2017 年更新版与 2012 年适用标准（AUC）下非急性冠状动脉综合征患者的冠状动脉血运重建适宜性。
背景
2017 年，冠状动脉血运重建的 2012 年 AUC 进行了更新。我们研究了在我们之前的不适当病例中应用这些新的 2017 年更新会如何改变它们的适宜性。
方法
我们确定了 50 例因 2012 年 AUC 而被认为不适当的稳定型缺血性心脏病患者接受冠状动脉血运重建的病例。两名独立的医生审查了这些病例，并根据 2017 年 AUC 应用了新的 AUC。接下来，如果有变化，确定原因。
结果
平均年龄为 64 岁，大多数为男性（29 例，58%）。42 例（84%）在就诊时无症状。大多数病例（27 例，54%）涉及经皮冠状动脉介入治疗（PCI）右冠状动脉。应用 2017 年 AUC 后，50 例不适当失败中的 34 例（68%）将从“不适当”改为“可能适当的治疗”。在这 34 例中，由于新 AUC 不再要求 PCI 前患者使用≥2 种抗心绞痛药物，25 例（73.5%）发生变化。在这 34 例中，由于新 AUC 扩大了非侵入性方法的应用，有 8 例（23.5%）发生了变化。
结论
应用 2017 年 AUC 导致更多的病例被认为“可能适当”。变化的最常见原因包括抗心绞痛方案的要求变化和非侵入性方法的作用扩大。
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