Geisinger Health System, Danville, Pennsylvania.
Geisinger Health System, Danville, Pennsylvania.
Am J Cardiol. 2021 Dec 1;160:31-39. doi: 10.1016/j.amjcard.2021.07.051.
Chest pain (CP) has been reported in 20% to 40% of patients 1 year after percutaneous coronary intervention (PCI), though rates of post-PCI health-care utilization (HCU) for CP in nonclinical trial populations are unknown. Furthermore, the contribution of noncardiac factors - such as pulmonary, gastrointestinal, and psychological - to post-PCI CP HCU is unclear. Accordingly, the objectives of this study were to describe long-term trajectories and identify predictors of post-PCI CP-related HCU in real-world patients undergoing PCI for any indication. This retrospective cohort study included patients receiving PCI for any indication from 2003 to 2017 through a single integrated health-care system. Post-PCI CP-related HCU tracked through electronic medical records included (1) office visits, (2) emergency department (ED) visits, and (3) hospital admissions with CP or angina as the primary diagnosis. The strongest predictors of CP-related HCU were identified from >100 candidate variables. Among 6386 patients followed an average of 6.7 years after PCI, 73% received PCI for acute coronary syndrome (ACS), 19% for stable angina, and 8% for other indications. Post-PCI CP-related HCU was common with 26%, 16%, and 5% of patients having ≥1 office visits, ED visits, and hospital admissions for CP within 2 years of PCI. The following factors were significant predictors of all 3 CP outcomes: ACS presentation, documented CP >7 days prior to the index PCI, anxiety, depression, and syncope. In conclusion, CP-related HCU following PCI was common, especially within the first 2 years. The strongest predictors of CP-related HCU included coronary disease attributes and psychological factors.
胸痛（CP）在经皮冠状动脉介入治疗（PCI）后 1 年的患者中发生率为 20%至 40%，但在非临床试验人群中，PCI 后因 CP 而产生的医疗保健利用（HCU）率尚不清楚。此外，非心脏因素（如肺部、胃肠道和心理因素）对 PCI 后 CP HCU 的贡献尚不清楚。因此，本研究的目的是描述长期轨迹，并确定在接受任何适应证 PCI 的真实世界患者中与 PCI 后 CP 相关的 HCU 的预测因素。这项回顾性队列研究纳入了 2003 年至 2017 年期间通过单一综合医疗保健系统接受任何适应证 PCI 的患者。通过电子病历跟踪 PCI 后与 CP 相关的 HCU 包括（1）就诊，（2）急诊部（ED）就诊，（3）以 CP 或心绞痛为主要诊断的住院。从 100 多个候选变量中确定了与 CP 相关的 HCU 的最强预测因素。在平均随访 PCI 后 6.7 年的 6386 例患者中，73%的患者因急性冠脉综合征（ACS）而接受 PCI，19%的患者因稳定型心绞痛而接受 PCI，8%的患者因其他适应证而接受 PCI。PCI 后 2 年内，26%、16%和 5%的患者因 CP 接受≥1 次就诊、ED 就诊和因 CP 住院。以下因素是所有 3 个 CP 结果的显著预测因素：ACS 表现、PCI 前 7 天内记录的 CP、焦虑、抑郁和晕厥。总之，PCI 后与 CP 相关的 HCU 很常见，尤其是在最初的 2 年内。CP 相关 HCU 的最强预测因素包括冠心病特征和心理因素。
