在有和没有现场心脏手术服务的中心接受治疗的多支血管疾病患者的中期结果。

Midterm outcomes of patients with multivessel disease treated at centers with and without on-site cardiac surgery services.

作者信息

Ram Eilon, Raanani Ehud, Klempfner Robert, Peled Yael, Sternik Leonid, Segev Amit

机构信息

Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

J Thorac Cardiovasc Surg. 2022 May;163(5):1852-1861.e3. doi: 10.1016/j.jtcvs.2020.04.170. Epub 2020 May 30.

DOI:10.1016/j.jtcvs.2020.04.170

PMID:32711976

Abstract

OBJECTIVE

The last decade has witnessed an increased number of stand-alone interventional cardiology units due to the consolidation of cardiac surgery services. We aimed to explore the impact of a heart team on the midterm outcomes of patients with multivessel coronary artery disease.

METHODS

This prospective registry included 1063 consecutive patients with multivessel disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography and percutaneous coronary intervention, with or without on-site cardiac surgery services.

RESULTS

Of the 1063 patients, 576 (54%) and 487 (46%) were admitted to centers with or without on-site cardiac surgery services, respectively. Centers with cardiac surgery services compared with those without had more male patients (82% vs 77%, P = .026) and more patients who were taking aspirin (75% vs 67%, P = .008) before admission. Other characteristics were similar between the groups, including mean SYNTAX score (22.5 ± 9.6 vs 22.2 ± 10, P = .680). Late outcomes revealed a higher 6-year survival probability in centers with on-site cardiac surgery services (85.1% vs 81.3%, P = .047). Although coronary artery bypass grafting (vs percutaneous coronary intervention) was associated with a survival advantage among patients from hospitals with cardiac surgery services (89.9% vs 81.5%, P = .004), in the absence of on-site cardiac surgery services there were no differences between the 2 revascularization approaches (81.8% vs 81.1%, P = .9).

CONCLUSIONS

Patients with multivessel coronary artery disease treated in centers without on-site cardiac surgery services receive a lower rate of appropriate guideline-based intervention with coronary artery bypass grafting, which is associated with less favorable outcomes. These findings suggest that a heart-team approach should be mandatory even in centers with stand-alone interventional cardiology units.

摘要

目的

由于心脏外科服务的整合，过去十年中独立的介入心脏病学单元数量有所增加。我们旨在探讨心脏团队对多支冠状动脉疾病患者中期结局的影响。

方法

这项前瞻性登记研究纳入了2013年1月至4月期间以色列所有22家进行冠状动脉造影和经皮冠状动脉介入治疗（无论有无现场心脏外科服务）的医院连续收治的1063例多支血管疾病患者。

结果

在1063例患者中，分别有576例（54%）和487例（46%）被收治到有或无现场心脏外科服务的中心。有心脏外科服务的中心与没有心脏外科服务的中心相比，男性患者更多（82%对77%，P = 0.026），入院前服用阿司匹林的患者更多（75%对67%，P = 0.008）。两组的其他特征相似，包括平均SYNTAX评分（22.5±9.6对22.2±10，P = 0.680）。晚期结局显示，有现场心脏外科服务的中心6年生存概率更高（85.1%对81.3%，P = 0.047）。尽管在有心脏外科服务的医院中，冠状动脉旁路移植术（与经皮冠状动脉介入治疗相比）与生存优势相关（89.9%对81.5%，P = 0.004），但在没有现场心脏外科服务的情况下，两种血运重建方法之间没有差异（81.8%对81.1%，P = 0.9）。