Serviço de Cardiologia do Centro Hospitalar Barreiro-Montijo, Lisboa, Portugal; Centro Nacional de Colheita de Dados em Cardiologia, Sociedade Portuguesa de Cardiologia, Coimbra, Portugal; Investigadores do Registo Nacional de Síndromes Coronárias Agudas.
Serviço de Cardiologia do Centro Hospitalar Barreiro-Montijo, Faculdade de Medicina, Universidade de Lisboa, Portugal; Centro Nacional de Colheita de Dados em Cardiologia, Sociedade Portuguesa de Cardiologia, Coimbra, Portugal; Investigadores do Registo Nacional de Síndromes Coronárias Agudas.
Rev Port Cardiol (Engl Ed). 2021 Mar;40(3):169-188. doi: 10.1016/j.repc.2020.06.019. Epub 2021 Jan 29.
In an era in which coronary heart disease is one of the leading causes of death worldwide, several studies report the persistence of obstacles to accessing revascularization, and percutaneous coronary intervention in particular, which may be associated with worse outcomes.
To compare cardiovascular outcomes in patients admitted to hospitals with and without on-site percutaneous coronary intervention (PCI) capabilities.
A retrospective study based on the National Registry of Acute Coronary Syndromes (ACS) - with data collection from 2010 to 2018. Division of the patients into two groups: with and without ST-elevation. Two subgroups were subsequently created according to the presence/absence of on-site PCI. A propensity score was performed to standardize the results. Patients without information about hospital admission (with/without PCI) were excluded.
6008 patients were included after exclusion criteria and propensity score were applied. We found that patients admitted for ACS with ST-elevation (STE-ACS) had more episodes of sustained ventricular tachycardia (OR 2.14; CI (1.26-3.61); p=0.004) in hospitals without on-site PCI. Regarding ACS without ST elevation (NSTE-ACS), there were more cases of congestive heart failure (OR 0.79; CI (0.65-0.98)) in hospitals with on-site PCI.
The incidence of a greater number of major adverse events in hospitalizations without on-site PCI, particularly in the case of STE-ACS, is a consequence of the delay before revascularization. National and local strategies must be established to reduce the negative impact of the absence of on-site PCI and the resulting time before revascularization.
在全球范围内，冠心病是导致死亡的主要原因之一，有多项研究报告称，存在获得血运重建，特别是经皮冠状动脉介入治疗（PCI）的障碍，这可能与更差的预后有关。
比较具有和不具有经皮冠状动脉介入（PCI）能力的医院住院患者的心血管结局。
这是一项基于国家急性冠状动脉综合征登记（ACS）的回顾性研究，数据收集时间为 2010 年至 2018 年。将患者分为有和无 ST 段抬高两组。随后根据是否存在现场 PCI 创建了两个亚组。进行倾向评分以标准化结果。排除无医院入院（有无 PCI）信息的患者。
在应用排除标准和倾向评分后，纳入了 6008 例患者。我们发现，因 ST 段抬高的急性冠状动脉综合征（STE-ACS）而住院的患者在无现场 PCI 的医院中更易发生持续性室性心动过速（OR 2.14；95%CI（1.26-3.61）；p=0.004）。对于无 ST 段抬高的急性冠状动脉综合征（NSTE-ACS），有现场 PCI 的医院中充血性心力衰竭的病例更多（OR 0.79；95%CI（0.65-0.98））。
无现场 PCI 的医院住院患者发生更多主要不良事件的发生率更高，特别是在 STE-ACS 的情况下，这是血运重建延迟的结果。必须制定国家和地方策略，以减少无现场 PCI 及由此导致的血运重建前时间的负面影响。
