Department of Cardiology, University Hospital of Wales, Cardiff, UK.
Department of Cardiology, University Hospital of Wales, Cardiff, UK.
Am Heart J. 2020 Apr;222:15-25. doi: 10.1016/j.ahj.2019.12.019. Epub 2020 Jan 7.
Complex high-risk and indicated revascularization using percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly studied.
To define temporal changes in CHIP-PCI volumes, and the relationship between operator CHIP-PCI volume and patient outcomes.
Data were analyzed on all CHIP-PCI procedures undertaken for stable angina in England and Wales between 2007 and 2014. Operator volume data was available for 2012-14. CHIP-PCI was defined by patient characteristics (age ≥80years, left ventricular (LV) ejection fraction <30%, previous CABG, or chronic renal failure) and/or by procedural characteristics (left main PCI, chronic total occlusion PCI, LV support, use of rotational atherectomy or laser atherectomy). CHIP-PCI as a percentage of total PCI increased from 28.1% in 2007 to 36.2% in 2014 (P < .001). Between 2012 and 2014, a total of 30,268 CHIP-PCI cases were performed. Total operator volume varied from 1 to 580 cases with median total operator volume of 29 cases. Higher operator volumes were associated with a greater degree of patient comorbidity and increasing procedural complexity. After adjustment for baseline difference, in-hospital major bleeding (P < .001 for trend), access site complications (P < .001) and coronary perforation (P = .002) were associated with increasing operator CHIP-PCI volumes. However, the frequency of in-hospital death (P = .394) and 12-month mortality (P = .638) were similar across the volume quartiles. Higher volumes quartiles were associated with a greater likelihood of same day discharge (P < .001).
CHIP-PCI cases are an increasingly large population in contemporary PCI practice. Higher operator volumes were not associated with improved 12-month survival.
Data were analyzed on all complex high-risk and indicated revascularization using percutaneous coronary intervention (CHIP-PCI) procedures in England and Wales between 2007 and 2014. CHIP-PCI as a percentage of total PCI increased from 28.1% in 2007 to 36.2% in 2014 (P < .001). Median total operator volume was 29 cases with higher volumes associated with more patient comorbidity and increasing procedural complexity. In-hospital major bleeding (P < .001 for trend), access site complications (P < .001) and coronary perforation (P = .002) all associated with increasing operator CHIP-PCI volumes. However, trends for in-hospital death (P = .394), and 12-month mortality (P = .638) were similar across the volume quartiles.
复杂高危和有指征的经皮冠状动脉介入治疗（CHIP-PCI）是一个新兴的概念，研究甚少。
定义 CHIP-PCI 量的时间变化，以及术者 CHIP-PCI 量与患者结局之间的关系。
分析了 2007 年至 2014 年期间英格兰和威尔士稳定型心绞痛患者所有接受的 CHIP-PCI 手术的数据。2012-2014 年可获得术者量数据。CHIP-PCI 由患者特征（年龄≥80 岁、左心室射血分数<30%、既往 CABG 或慢性肾功能衰竭）和/或手术特征（左主干 PCI、慢性完全闭塞 PCI、左心室支持、使用旋磨或激光旋磨）定义。2007 年 CHIP-PCI 占总 PCI 的 28.1%，2014 年增至 36.2%（P<0.001）。2012 年至 2014 年，共进行了 30268 例 CHIP-PCI。术者总量从 1 例到 580 例不等，中位数为 29 例。术者量越大，患者合并症越多，手术难度越大。在调整基线差异后，住院期间大出血（趋势 P<0.001）、入路部位并发症（趋势 P<0.001）和冠状动脉穿孔（P=0.002）与术者 CHIP-PCI 量增加相关。然而，住院期间死亡（P=0.394）和 12 个月死亡率（P=0.638）在各四分位组间相似。较高的四分位组与更高的当天出院率相关（P<0.001）。
CHIP-PCI 病例是当代 PCI 实践中越来越大的人群。术者量增加与 12 个月生存率的提高无关。
