Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia.
Cardiovasc Revasc Med. 2021 Oct;31:10-16. doi: 10.1016/j.carrev.2020.12.019. Epub 2020 Dec 17.
Patient selection and procedural characteristics continue to evolve in percutaneous coronary intervention (PCI). Australian data on long-term trends and outcomes are limited. This study aimed to identify long-term temporal trends in patient characteristics and outcomes in a large Australian PCI cohort.
We analysed data from 41,146 PCI procedures included in the multi-centre Melbourne Interventional Group registry to determine trends in patient characteristics, procedural practices and outcomes from 2005 to 2018. Procedures were divided into 2-yearly periods for trends analysis.
Temporal trends in patient characteristics showed increases in age, proportion of males, rates of obesity, insulin-requiring diabetes mellitus, current smoking, obstructive sleep apnoea and prior PCI (all P < 0.01). Increases in the proportion of ST-elevation myocardial infarction, cardiogenic shock or out-of-hospital cardiac arrest (OHCA) were observed, and CathPCI National Cardiovascular Data Registry mortality risk scores increased over time (all P < 0.01). Use of radial access and drug-eluting stents increased, and lesions treated were more frequently ostial, left main or ACC/AHA type B2/C in recent years (all P < 0.01). In contrast, major bleeding and no reflow rates declined, however 30-day mortality, 12-month mortality and rates of stroke increased (all P < 0.01). Rates of vascular complications and 30-day target vessel revascularisation remained similar. In multivariable analysis, 2-yearly time periods were not independently associated with risk of 30-day mortality or 30-day MACE.
Over the last 14 years, Australian PCI procedural complexity and patient risk profiles have increased. Higher mortality rates appear to relate to increased patient risk profile rather than procedural factors.
经皮冠状动脉介入治疗（PCI）中患者选择和程序特征仍在不断发展。澳大利亚在长期趋势和结果方面的数据有限。本研究旨在确定大型澳大利亚 PCI 队列中患者特征和结果的长期时间趋势。
我们分析了来自多中心墨尔本介入组注册中心的 41146 例 PCI 手术的数据，以确定 2005 年至 2018 年期间患者特征、手术操作和结果的趋势。将手术分为 2 年为一个时间段进行趋势分析。
患者特征的时间趋势显示年龄、男性比例、肥胖率、需要胰岛素的糖尿病、当前吸烟、阻塞性睡眠呼吸暂停和既往 PCI 的比例均增加（均 P<0.01）。观察到 ST 段抬高型心肌梗死、心源性休克或院外心脏骤停（OHCA）的比例增加，并且 CathPCI 国家心血管数据注册死亡率风险评分随时间增加（均 P<0.01）。桡动脉入路和药物洗脱支架的使用率增加，近年来治疗的病变更常位于开口、左主干或 ACC/AHA 类型 B2/C（均 P<0.01）。相反，大出血和无复流的发生率下降，但 30 天死亡率、12 个月死亡率和卒中发生率增加（均 P<0.01）。血管并发症和 30 天靶血管血运重建的发生率保持相似。多变量分析显示，2 年时间段与 30 天死亡率或 30 天主要不良心脏事件（MACE）的风险无关。
在过去的 14 年中，澳大利亚 PCI 手术的复杂性和患者风险特征有所增加。更高的死亡率似乎与患者风险特征的增加有关，而不是手术因素。
