Health Statistics Department, Shanghai Statistics Center for Health, Shanghai, People's Republic of China.
School of Public Health, NHC Key Laboratory of Health Technology Assessment (Fudan University), Fudan University, Shanghai, People's Republic of China.
PLoS One. 2024 Apr 1;19(4):e0301448. doi: 10.1371/journal.pone.0301448. eCollection 2024.
This study aimed to analyze the effect of coronary stent policies implemented in Shanghai on the risk of percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) inpatients based on real-world data.
Two retrospective cohorts of inpatients with a first diagnosis of ACS who had undergone PCI for the first time in the previous year in Shanghai hospitals were examined (one for the postpolicy period and the other for the prepolicy period). χ2 tests were used to compare categorical variables between the two cohorts. Single- and multivariate Cox proportional hazards models were used to compare the risk of major adverse cardiovascular events (MACEs) between the two cohorts.
A total of 31,760 ACS patients were included in this study. The proportion of ACS inpatients who had at least one bid-winning stent and 3 or more coronary stents implanted for first-time PCI in the postpolicy cohort was higher than that in the prepolicy cohort (86.52% vs. 55.67% and 6.27% vs. 4.39%, respectively; all p values < 0.0001). The single- and multivariate Cox proportional hazards models revealed that the unadjusted and adjusted hazard ratios for MACEs at 1 year after PCI for the postpolicy cohort relative to the prepolicy cohort were 0.869 (P<0.0001) and 0.814 (P = 0.0007), respectively.
The implementation of coronary stent policies changed coronary stent utilization but had no significant adverse effects on the risk of PCI among ACS patients in Shanghai in the short term. However, the reasons for changes in the number of coronary stents implanted should be analyzed and addressed in the future.
本研究旨在基于真实世界数据，分析上海实施冠状动脉支架政策对急性冠状动脉综合征（ACS）住院患者经皮冠状动脉介入治疗（PCI）风险的影响。
对前一年在上海医院首次接受 PCI 的 ACS 住院患者的两个回顾性队列（一个为政策后队列，另一个为政策前队列）进行检查。使用 χ2 检验比较两个队列之间的分类变量。使用单因素和多因素 Cox 比例风险模型比较两个队列之间主要不良心血管事件（MACE）的风险。
本研究共纳入 31760 例 ACS 患者。政策后队列中至少有一个中标支架和首次 PCI 植入 3 个或更多冠状动脉支架的 ACS 住院患者比例高于政策前队列（86.52%比 55.67%和 6.27%比 4.39%；所有 P 值均<0.0001）。单因素和多因素 Cox 比例风险模型显示，政策后队列 PCI 后 1 年 MACE 的未调整和调整危险比相对于政策前队列分别为 0.869（P<0.0001）和 0.814（P=0.0007）。
冠状动脉支架政策的实施改变了冠状动脉支架的使用情况，但在短期内对上海 ACS 患者 PCI 风险没有显著的不良影响。然而，未来应分析和解决冠状动脉支架植入数量变化的原因。
