更高的无保护左主干经皮冠状动脉介入术（ULMCA）手术量与改善患者预后相关吗？：来自英国心血管介入学会国家数据库的 6724 例手术的生存分析。
Are Higher Operator Volumes for Unprotected Left Main Stem Percutaneous Coronary Intervention Associated With Improved Patient Outcomes?: A Survival Analysis of 6724 Procedures From the British Cardiovascular Intervention Society National Database.
机构信息
Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., R.A., A.S., V.F.).
Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom (T.K., M.M.).
出版信息
Circ Cardiovasc Interv. 2020 Jun;13(6):e008782. doi: 10.1161/CIRCINTERVENTIONS.119.008782.
BACKGROUND
The relationship between operator volume and survival after unprotected left main stem percutaneous coronary intervention (uLMS-PCI) is poorly defined.
METHODS
Data from the British Cardiovascular Intervention Society national PCI database were analyzed for all uLMS-PCI procedures performed in England and Wales between 2012 and 2014 and 4 quartiles of annualized uLMS-PCI volume (Q1-Q4) generated. Individual logistic regressions were performed for 12-month mortality to quantify the independent association between operator quartile and outcomes.
RESULTS
In total, 6724 uLMS-PCI procedures were analyzed with a negatively skewed distribution and an annualized median of 3 procedures per year. Operator volume ranged from 1 to 54 uLMS-PCI procedures/year. Within Q1, 347 operators performed a median of 2 procedures/year (interquartile range, 1-3); in Q2, 134 operators performed a median of 5 procedures/year (interquartile range, 4-6); in Q3, 59 operators performed a mean of 10 procedures/year (interquartile range, 8-12); and in Q4, 29 operators performed a mean of 21 procedures/year (interquartile range, 17-29). Higher volume operators undertook uLMS-PCI in patients with greater comorbid burden and performed more complex procedures compared with lower operator volumes. Adjusted in-hospital survival (odds ratio, 0.39 [95% CI, 0.24-0.67]; <0.001), in-hospital major adverse cardiac and cerebral events (odds ratio, 0.41 [95% CI, 0.27-0.62]; <0.001), and 12-month survival (odds ratio, 0.54 [95% CI, 0.39-0.73]; <0.001) were lower in Q4 operators compared with Q1 operators. A close association between operator volume/case and superior 12-month survival was observed (<0.001). The lower volume threshold of minimum operator uLMS-PCI volume associated with improved survival was ≥16 cases/year.
CONCLUSIONS
These data suggest that operator volume is an important factor in determining outcome after uLMS-PCI.
背景
在未经保护的左主干经皮冠状动脉介入治疗（uLMS-PCI）后，术者手术量与生存率之间的关系尚未明确。
方法
对 2012 年至 2014 年在英格兰和威尔士进行的所有 uLMS-PCI 手术的英国心血管介入学会全国 PCI 数据库数据进行分析，并生成了每年 uLMS-PCI 量的 4 个四分位数（Q1-Q4）。对 12 个月死亡率进行个体逻辑回归分析，以量化术者四分位与结局之间的独立关联。
结果
共分析了 6724 例 uLMS-PCI 手术，呈负偏态分布，每年的中位数为 3 例。术者手术量范围为 1 至 54 例/uLMS-PCI 手术/年。在 Q1 中，347 名术者每年进行中位数为 2 例的手术（四分位距，1-3）；在 Q2 中，134 名术者每年进行中位数为 5 例的手术（四分位距，4-6）；在 Q3 中，59 名术者每年进行中位数为 10 例的手术（四分位距，8-12）；在 Q4 中，29 名术者每年进行中位数为 21 例的手术（四分位距，17-29）。与低术者量相比，高术者量的术者在接受 uLMS-PCI 的患者中合并症负担更重，且进行了更复杂的手术。校正后的住院期间生存率（比值比，0.39[95%置信区间，0.24-0.67]；<0.001）、住院期间主要心脑血管不良事件（比值比，0.41[95%置信区间，0.27-0.62]；<0.001）和 12 个月生存率（比值比，0.54[95%置信区间，0.39-0.73]；<0.001）在 Q4 术者中低于 Q1 术者。观察到术者数量/例与 12 个月生存率的密切关联（<0.001）。与改善生存率相关的术者接受 uLMS-PCI 的最低手术量阈值为≥16 例/年。
结论
这些数据表明，术者手术量是决定 uLMS-PCI 术后结局的重要因素。
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