Hulme William J, Sperrin Matthew, Martin Glen Philip, Curzen Nick, Ludman Peter, Kontopantelis Evangelos, Mamas Mamas A
Farr Institute, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
University Hospital Southampton and Faculty of Medicine, University of Southampton, Southampton, UK.
BMJ Open. 2019 Feb 19;9(2):e024627. doi: 10.1136/bmjopen-2018-024627.
Percutaneous coronary intervention (PCI) has seen substantial shifts in patient selection in recent years that have increased baseline patient mortality risk. It is unclear to what extent observed changes in mortality are attributable to background mortality risk or the indication and selection for PCI itself. PCI-attributable mortality can be estimated using relative survival, which adjusts observed mortality by that seen in a matched control population. We report relative survival ratios and compare these across different time periods.
National Health Service PCI activity in England and Wales from 2007 to 2014 is considered using data from the British Cardiovascular Intervention Society PCI Registry. Background mortality is as reported in Office for National Statistics life tables. Relative survival ratios up to 1 year are estimated, matching on patient age, sex and procedure date. Estimates are stratified by indication for PCI, sex and procedure date.
549 305 procedures were studied after exclusions for missing age, sex, indication and mortality status. Comparing from 2007 to 2008 to 2013-2014, differences in crude survival at 1 year were consistently lower in later years across all strata. For relative survival, these differences remained but were smaller, suggesting poorer survival in later years is partly due to demographic characteristics. Relative survival was higher in older patients.
Changes in patient demographics account for some but not all of the crude survival changes seen during the study period. Relative survival is an under-used methodology in interventional settings like PCI and should be considered wherever survival is compared between populations with different demographic characteristics, such as between countries or time periods.
近年来，经皮冠状动脉介入治疗（PCI）在患者选择方面发生了重大变化，这增加了患者的基线死亡风险。目前尚不清楚观察到的死亡率变化在多大程度上可归因于背景死亡风险或PCI本身的适应证及选择。PCI归因死亡率可通过相对生存率进行估算，即根据匹配对照组人群的死亡率对观察到的死亡率进行调整。我们报告相对生存率，并比较不同时间段的情况。
利用英国心血管介入学会PCI注册中心的数据，对2007年至2014年英格兰和威尔士国民医疗服务体系的PCI活动进行研究。背景死亡率如英国国家统计局生命表中所报告。估算1年内的相对生存率，根据患者年龄、性别和手术日期进行匹配。估算结果按PCI适应证、性别和手术日期进行分层。
排除年龄、性别、适应证和死亡状态缺失的数据后，共研究了549305例手术。比较2007 - 2008年与2013 - 2014年的数据，各分层中1年时的粗生存率差异在后期年份持续降低。对于相对生存率，这些差异仍然存在，但较小，这表明后期生存率较差部分归因于人口统计学特征。老年患者的相对生存率较高。
患者人口统计学特征的变化解释了研究期间观察到的部分而非全部粗生存率变化。相对生存率是PCI等介入治疗环境中未充分利用的方法，在比较不同人口统计学特征人群（如不同国家或不同时间段）的生存率时应予以考虑。
