血管内超声用于 ST 段抬高型心肌梗死的应用及再入院率的国家趋势。
National trends of utilization and readmission rates with intravascular ultrasound use for ST-elevation myocardial infarction.
机构信息
Department of Cardiology, Ochsner-Louisiana State University, Shreveport, Louisiana, USA.
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
出版信息
Catheter Cardiovasc Interv. 2021 Jul 1;98(1):1-9. doi: 10.1002/ccd.29524. Epub 2021 Feb 11.
BACKGROUND
Randomized trials have confirmed that intravascular ultrasound (IVUS) guidance for percutaneous coronary interventions (PCI) improves long-term clinical outcomes. However, data on real-world utilization of IVUS in ST-elevation myocardial infarction (STEMI) and the impact on short to mid-term outcomes are scarce. We sought to evaluate the utilization and the readmission rates for IVUS-guided PCI in the setting of STEMI.
METHODS
Hospitalizations with a primary diagnosis of STEMI undergoing PCI were included from the Nationwide Readmissions Database (NRD) during 2012-2017.
RESULTS
Among 809,601 hospitalizations with STEMI undergoing PCI, 33,644 (4.2%) underwent IVUS-guided PCI. IVUS use increased from 4.2% in 2012 to 5.6% in 2017 (p < .0001). After matching, in-hospital mortality was significantly lower with IVUS use (3.9% vs. 4.6%, p < .0001). The overall readmission rates were similar in both groups. We found that readmission rates due to acute MI at 6 months (5.7% vs. 6%, p = .045) and 11 months (5.1% vs. 6.5%, p = .005) as well as the PCI and mortality rates during readmission at 11 months (2.1% vs. 3%, p = .008, and 0.7% vs. 1.4%, p = .002, respectively) were significantly lower in the IVUS group.
CONCLUSIONS
The utilization of IVUS in STEMI appears to be slowly increasing. Although overall readmission rates were similar, IVUS was associated with lower in-hospital mortality, lower rates of readmission due to acute MI at 6 and 11 months, as well as lower PCI and mortality at 11 months. Randomized trials evaluating long-term benefits of IVUS in STEMI are needed.
背景
随机试验已经证实血管内超声（IVUS）指导经皮冠状动脉介入治疗（PCI）可改善长期临床结果。然而，关于 ST 段抬高型心肌梗死（STEMI）中 IVUS 的实际应用以及对短期至中期结果的影响的数据却很少。我们旨在评估 STEMI 患者中 IVUS 指导 PCI 的应用情况和再入院率。
方法
从 2012 年至 2017 年，全美再入院数据库（NRD）中纳入因 STEMI 行 PCI 的住院患者。
结果
在因 STEMI 行 PCI 的 809601 例住院患者中，33644 例（4.2%）行 IVUS 指导 PCI。IVUS 的使用率从 2012 年的 4.2%增加到 2017 年的 5.6%（p<0.0001）。匹配后，IVUS 组院内死亡率显著降低（3.9% vs. 4.6%，p<0.0001）。两组的总体再入院率相似。我们发现，6 个月（5.7% vs. 6%，p=0.045）和 11 个月（5.1% vs. 6.5%，p=0.005）时因急性心肌梗死再入院率以及 11 个月时再入院的 PCI 率和死亡率（2.1% vs. 3%，p=0.008 和 0.7% vs. 1.4%，p=0.002）均显著降低。
结论
在 STEMI 中 IVUS 的应用似乎正在缓慢增加。尽管总体再入院率相似，但 IVUS 与较低的院内死亡率、6 个月和 11 个月时因急性心肌梗死再入院率以及 11 个月时再入院的 PCI 率和死亡率相关。需要进行随机试验来评估 IVUS 在 STEMI 中的长期获益。
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