Kumsa Netsanet B, Kelly Thu-Lan, Roughead Elizabeth E, Tavella Rosanna, Gillam Marianne H
Clinical and Health Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Australia.
Faculty of Health and Medical Sciences, The University of Adelaide, Australia.
Hellenic J Cardiol. 2024 Nov-Dec;80:21-30. doi: 10.1016/j.hjc.2023.10.002. Epub 2023 Oct 18.
The aim of this study was to describe the trend in percutaneous coronary intervention (PCI) with insertion of a stent in Australia from 2000/01 to 2020/21 and investigate trends in same-day versus non-same-day discharge following PCI. A secondary aim was to compare the rate of coronary artery bypass grafting (CABG) with PCI procedures, while a third aim was to compare marked PCI trend changes with the PCI guidelines during the study period.
PCI with stent deployment is the most common form of interventional treatment for coronary artery disease, and its use has been expanding since 2000. However, there is a lack of descriptive studies of the national trend in Australia.
All procedures for PCI and CABG were extracted across 21 years (2000/01 to 2020/21) from the Australian Institute of Health and Welfare data. Age-standardized rates were calculated using the Australian standard population as of June 2001. The ratio of PCI to CABG procedures was also calculated. Trends for PCI were stratified by age, gender, and same-day or overnight discharge episodes. Linear regression analysis was done to compare the age-standardized rates across different age categories. Segmented regression analysis was performed to ascertain the change in the age-standardized rates of PCI during the study period. Whether the changepoints in the trend were matched with guideline updates was also assessed.
There were 751 728 PCI procedures in persons aged 30 years and above between 2000/01 and 2020/21. The age-standardized rate for the study period showed that persons aged 60-74 years had a higher rate of procedures (102.7) compared to persons aged 30-59 years (81.3) and 75 years and older (61.8) (P < 0.001). There were two statistically significant changepoints in the overall trend; 2005/06 and 2013/14, matched with the change in PCI guidelines. Despite the lower number of procedures for same-day discharge episodes, there has been an increasing trend since 2014/15. More than two-thirds of all stenting procedures were the insertion of a single stent. PCI to CABG procedure ratio increased from 0.6 in 2000/01 to 1.8 in 2020/21.
There was a varying trend in the age-standardized rate of PCI with a peak in 2005/06. The trend appears to be stabilizing in the later part of the study period, but the rate for same-day discharge episodes showed an increasing trend after 2014/15. There is consistency with changepoints in the trend and updated PCI guideline recommendations. The ratio of PCI with insertion of a stent to CABG procedure increased substantially across the study period.
本研究旨在描述2000/01至2020/21年澳大利亚经皮冠状动脉介入治疗（PCI）并植入支架的趋势，并调查PCI后当日出院与非当日出院的趋势。次要目的是比较冠状动脉旁路移植术（CABG）与PCI手术的比率，第三个目的是比较研究期间显著的PCI趋势变化与PCI指南。
植入支架的PCI是冠状动脉疾病最常见的介入治疗形式，自2000年以来其使用一直在增加。然而，澳大利亚缺乏关于全国趋势的描述性研究。
从澳大利亚卫生与福利研究所的数据中提取了21年（2000/01至2020/21年）所有的PCI和CABG手术。使用截至2001年6月的澳大利亚标准人口计算年龄标准化率。还计算了PCI与CABG手术的比率。PCI的趋势按年龄、性别以及当日或过夜出院情况进行分层。进行线性回归分析以比较不同年龄组的年龄标准化率。进行分段回归分析以确定研究期间PCI年龄标准化率的变化。还评估了趋势中的变化点是否与指南更新相匹配。
2000/01至2020/21年，30岁及以上人群中有751728例PCI手术。研究期间的年龄标准化率显示，60 - 74岁人群的手术率（102.7）高于30 - 59岁人群（81.3）和75岁及以上人群（61.8）（P < 0.001）。总体趋势有两个具有统计学意义的变化点；2005/06年和2013/14年，与PCI指南的变化相匹配。尽管当日出院情况的手术数量较少，但自2014/15年以来呈上升趋势。所有支架植入手术中超过三分之二是植入单个支架。PCI与CABG手术的比率从2000/01年的0.6增加到2020/21年的1.8。
PCI的年龄标准化率呈不同趋势，在2005/06年达到峰值。在研究后期趋势似乎趋于稳定，但当日出院情况的比率在2014/15年后呈上升趋势。趋势中的变化点与更新的PCI指南建议一致。在整个研究期间，植入支架的PCI与CABG手术的比率大幅增加。
