Unita' di Cardiologia, IRCCS MultiMedica, Milan.
Ospedale Riabilitativo ad Alta Specializzazione, Treviso.
J Cardiovasc Med (Hagerstown). 2019 Nov;20(11):762-767. doi: 10.2459/JCM.0000000000000835.
Although the benefits of percutaneous coronary interventions (PCIs) in patients with stable chronic ischemic heart disease (SIHD) are controversial, a large number of PCIs are currently performed in SIHD patients, frequently after coronary angiography (ad-hoc procedures), without the use of fractional flow reserve (FFR) to identify patients most likely to benefit from PCI.
Assessment of regional variations in PCI for SIHD performed in Italy in 2017 and correlation of the regional number of PCI per million inhabitants with the use of FFR were performed using the data reported in the registry of the Italian Society of Interventional Cardiology (SICI-GISE) registry for the year 2017.
PCI for SIHD accounted for 44.5% of all PCI performed in Italy with large variations among the Italian regions. There was a significant and inverse relationship between the use of FFR and the PCI number per million inhabitants performed for SIHD in the various Italian regions (P = 0.01). In the Veneto region, where local authorities mandated Heart Team reports to select the most appropriate treatment choice in multivessel disease patients, the rate of ad-hoc procedures was significantly lower than the national average.
PCI for SIHD patients represent almost half of all procedures currently performed in Italy with regional variations inversely related to physiologic guidance use. The mandatory assessment by the Heart Team to select the most appropriate treatment choice in multivessel disease patients is associated with a significantly lower number of ad-hoc procedures.
尽管经皮冠状动脉介入治疗（PCI）在稳定型慢性缺血性心脏病（SIHD）患者中的获益存在争议，但目前仍有大量的 PCI 用于 SIHD 患者，通常是在冠状动脉造影（即行 PCI 的指征）后进行，而未使用血流储备分数（FFR）来识别最有可能从 PCI 中获益的患者。
评估 2017 年意大利进行的用于 SIHD 的 PCI 的区域差异，并使用 2017 年意大利介入心脏病学会（SICI-GISE）注册中心报告的数据，将区域内每百万居民的 PCI 数量与 FFR 的使用情况进行相关性分析。
用于 SIHD 的 PCI 占意大利所有 PCI 的 44.5%，各意大利地区之间存在较大差异。意大利各地区 FFR 的使用情况与用于 SIHD 的每百万居民的 PCI 数量之间存在显著的负相关关系（P=0.01）。在威尼托地区，地方当局要求心脏团队报告来选择多血管疾病患者最合适的治疗选择，因此其即行 PCI 率明显低于全国平均水平。
用于 SIHD 患者的 PCI 占意大利目前进行的所有手术的近一半，区域差异与生理指导的使用呈负相关。心脏团队评估以选择多血管疾病患者最合适的治疗选择与即行 PCI 数量明显减少有关。
