Saito Yuichi, Inohara Taku, Kohsaka Shun, Ando Hirohiko, Ishii Hideki, Yamaji Kyohei, Amano Tetsuya, Kobayashi Yoshio, Kozuma Ken
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Am J Cardiol. 2023 Apr 1;192:182-189. doi: 10.1016/j.amjcard.2023.01.027. Epub 2023 Feb 21.
A lower institutional primary percutaneous coronary intervention (PCI) volume is associated with a higher risk of postprocedural poor outcomes, particularly in urgent or emergent settings (e.g., PCI for acute myocardial infarction [MI]). However, the individual prognostic impact of PCI volume stratified by indication and the relative ratio remains unclear. Using the Japanese nationwide PCI database, we investigated 450,607 patients from 937 institutions who underwent either primary PCI for acute MI or elective PCI. The primary end point was the observed/predicted in-hospital mortality ratio. The predicted mortality per patient was calculated using the baseline variables and averaged for each institution. The relation between the annual primary, elective, and total PCI volumes and institutional in-hospital mortality after acute MI was evaluated. The association between the primary-to-total PCI volume per hospital and mortality was also investigated. Of the 450,607 patients, 117,430 (26.1%) underwent primary PCI for acute MI, of whom 7,047 (6.0%) died during hospitalization. The median total PCI volume and primary-to-total PCI volume ratio were 198 (interquartile range 115 to 311) and 0.27 (0.20 to 0.36). Overall, the observed in-hospital mortality and observed/predicted mortality ratio in patients with acute MI were higher in institutions with lower primary, elective, and total PCI volumes. The observed/predicted mortality ratio was also higher in institutions with lower primary-to-total PCI volume ratios, even in high-PCI volume hospitals. In conclusion, in this nationwide registry-based analysis, lower institutional PCI volumes, regardless of setting, were associated with higher in-hospital mortality after acute MI. The primary-to-total PCI volume ratio provided independent prognostic information.
较低的机构原发性经皮冠状动脉介入治疗（PCI）量与术后不良结局风险较高相关，尤其是在紧急或急诊情况下（例如，急性心肌梗死[MI]的PCI）。然而，按适应证分层的PCI量的个体预后影响以及相对比例仍不清楚。利用日本全国PCI数据库，我们调查了来自937家机构的450,607例患者，这些患者接受了急性MI的原发性PCI或选择性PCI。主要终点是观察到的/预测的院内死亡率。使用基线变量计算每位患者的预测死亡率，并对每个机构进行平均。评估了年度原发性、选择性和总PCI量与急性MI后机构院内死亡率之间的关系。还研究了每家医院原发性与总PCI量之比与死亡率之间的关联。在450,607例患者中，117,430例（26.1%）接受了急性MI的原发性PCI，其中7,047例（6.0%）在住院期间死亡。总PCI量中位数和原发性与总PCI量之比分别为198（四分位间距115至311）和0.27（0.20至0.36）。总体而言，原发性、选择性和总PCI量较低的机构中，急性MI患者的观察到的院内死亡率和观察到的/预测的死亡率较高。即使在高PCI量医院中，原发性与总PCI量之比低的机构中观察到的/预测的死亡率也较高。总之，在这项基于全国登记处的分析中，无论情况如何，较低的机构PCI量与急性MI后较高的院内死亡率相关。原发性与总PCI量之比提供了独立的预后信息。
