Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Can J Cardiol. 2019 Oct;35(10):1394-1399. doi: 10.1016/j.cjca.2019.05.015. Epub 2019 May 20.
Patient characteristics, trends in the management strategy, and outcomes of patients with constrictive pericarditis have not been characterized at the national scale.
Annual trends of patients admitted to hospitals in the United States with constrictive pericarditis were evaluated using the National Inpatient Sample dataset between 2005 and 2014. Poisson regression models adjusting for the US census population estimate were fitted to evaluate trends in the incidence of constrictive pericarditis, isolated pericardiectomy, and cardiopulmonary bypass (CPB) use. Descriptive analyses were performed to compare patient characteristics and in-hospital mortality rates between surgically and medically managed cohorts.
During 2005-2014, 29,487 patients were admitted with constrictive pericarditis. Sixteen percent underwent isolated pericardiectomy. The prevalence of constrictive pericarditis remained stable between 2005 and 2014 at 9-10 cases per million, but proportion of patients undergoing isolated pericardiectomy decreased from 18% in 2005 to 15% in 2014 (P = 0.001 for trend). CPB use increased from 15% to 29% (P < 0.001). Compared with medically managed patients, the pericardiectomy cohort was younger (age 57 vs 61 years, P < 0.001), less likely to be female (25% vs 41%, P < 0.001), and harboured fewer comorbidities. In-hospital mortality was 7.3% for those undergoing pericardiectomy and 6.8% for a medically managed cohort (P = 0.58) and operative mortality was stable across years (P = 0.99 for trend).
The prevalence of constrictive pericarditis remained stable between 2005 and 2014 at 9-10 cases per million. Surgical management was infrequent, with younger and less comorbid patients being more likely to be managed operatively. Increasing use of CPB without a change in operative mortality highlights the persisting challenge of this complex disease.
在全国范围内，尚未对缩窄性心包炎患者的特征、治疗策略趋势和结局进行描述。
利用 2005 年至 2014 年美国国家住院患者样本数据集，评估每年因缩窄性心包炎住院的患者人数趋势。使用泊松回归模型调整美国人口普查估计值，以评估缩窄性心包炎、单纯性心包切除术和体外循环（CPB）使用率的发病率趋势。对手术和药物治疗队列的患者特征和住院死亡率进行描述性分析。
2005-2014 年期间，共有 29487 例患者因缩窄性心包炎住院。16%的患者接受了单纯性心包切除术。2005 年至 2014 年期间，缩窄性心包炎的患病率保持稳定，为每百万 9-10 例，但接受单纯性心包切除术的患者比例从 2005 年的 18%下降到 2014 年的 15%（趋势 P = 0.001）。CPB 的使用率从 15%增加到 29%（P < 0.001）。与药物治疗组相比，心包切除术组患者更年轻（年龄 57 岁 vs. 61 岁，P < 0.001），女性比例较低（25% vs. 41%，P < 0.001），合并症较少。心包切除术组住院死亡率为 7.3%，药物治疗组为 6.8%（P = 0.58），手术死亡率多年来保持稳定（趋势 P = 0.99）。
2005 年至 2014 年期间，缩窄性心包炎的患病率保持在每百万 9-10 例。手术治疗较为少见，年轻和合并症较少的患者更有可能接受手术治疗。CPB 的使用增加而手术死亡率没有变化，这突出了这种复杂疾病持续存在的挑战。
