Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan.
Am J Cardiol. 2022 Feb 15;165:12-18. doi: 10.1016/j.amjcard.2021.10.042. Epub 2021 Dec 7.
Chronic kidney disease (CKD) increases the risk of death and other poor outcomes in patients with cardiovascular diseases. This study investigated the relation between the institutional CKD percutaneous coronary intervention (PCI) volume and in-hospital clinical outcomes in patients with CKD. Among 1,199,901 patients who underwent PCI in 2014 to 2018 from the Japanese nationwide registry, we analyzed 220,509 patients with CKD. Patients were classified into quartiles (Q) according to the mean annual institutional CKD-PCI volume (Q1 <42 PCIs/year, Q2 <74 PCIs/year, Q3 <124 PCIs/year, Q4 ≥125 PCIs/year). The primary outcome was a composite of in-hospital death and periprocedural complications. The mean age of patients was 73 ± 10 years, and 36% (n = 78,332) were on dialysis. PCI was more likely to be performed with rotational atherectomy devices in high-volume institutions. Contrast volume was lower, the rate of radial access PCI was higher, and door-to-balloon time (for ST-elevation myocardial infarction) was shorter in the highest quartile institutions. Primary outcomes were observed in 6,539 patients (3.0%). The crude rate of the primary outcome was lowest in institutions with the highest PCI volume (Q1 3.4%, Q2 3.0%, Q3 3.0%, Q4 2.4%, p <0.001); higher PCI volume was associated with reduced frequency of the primary outcome (odds ratio [95% confidence interval] relative to Q1:Q2, 0.89 [0.83 to 0.96]; Q3 0.90 [0.84 to 0.97]; and Q4 0.76 [0.84 to 0.97]). In conclusion, the procedural characteristics and outcomes of PCI differed significantly by institutional volume in patients with CKD. When considering revascularization among these patients, institutional CKD-PCI volume needs to be incorporated in decision-making.
慢性肾脏病（CKD）增加了心血管疾病患者死亡和其他不良结局的风险。本研究调查了 2014 年至 2018 年期间日本全国注册中心接受经皮冠状动脉介入治疗（PCI）的 1199901 例患者中，CKD 患者的机构 CKD-PCI 量与住院临床结局之间的关系。在 220509 例 CKD 患者中，根据机构 CKD-PCI 年平均量（Q1<42 例/年、Q2<74 例/年、Q3<124 例/年、Q4≥125 例/年）将患者分为四分位（Q）。主要结局是住院期间死亡和围手术期并发症的复合结局。患者的平均年龄为 73±10 岁，36%（n=78332）接受透析治疗。在高容量机构中，更有可能使用旋切术装置进行 PCI。高容量机构的造影剂用量较低，经桡动脉入路 PCI 率较高，ST 段抬高型心肌梗死的门球时间较短。在最高四分位机构中，观察到 6539 例患者（3.0%）出现主要结局。在 PCI 量最高的机构中，主要结局的粗发生率最低（Q1 为 3.4%、Q2 为 3.0%、Q3 为 3.0%、Q4 为 2.4%，p<0.001）；较高的 PCI 量与主要结局发生频率降低相关（与 Q1 相比，比值比[95%置信区间]：Q2 为 0.89[0.83 至 0.96]；Q3 为 0.90[0.84 至 0.97]；Q4 为 0.76[0.84 至 0.97]）。总之，在 CKD 患者中，机构 PCI 量对手术特征和结局有显著影响。在考虑这些患者的血运重建时，需要将机构 CKD-PCI 量纳入决策。
