旋磨术和改良球囊血管成形术的手术安全性：来自德国国家登记处的见解。
Procedural safety of rotational atherectomy and modified balloon angioplasty: insights from a German national registry.
作者信息
Maier Alexander, Gissler Mark Colin, Jäckel Markus, Oettinger Vera, Bacmeister Lucas, Heidenreich Adrian, Rilinger Jonathan, Heger Lukas A, Bojti István, Weber Christian, Wolf Dennis, Hilgendorf Ingo, Rahimi Faridun, Ferenc Miroslaw, Westermann Dirk, Kaier Klaus, von Zur Mühlen Constantin
机构信息
Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
出版信息
Clin Res Cardiol. 2024 Sep 11. doi: 10.1007/s00392-024-02538-8.
BACKGROUND
Modified balloons (MB) and rotational atherectomy (RA) are recommended tools for treatment of coronary plaques with superficial calcium. Knowledge about in-hospital safety is limited.
METHODS
Patients with coronary artery disease who underwent coronary angiography with RA or MB angioplasty in Germany were identified via ICD and OPS codes from 2017 to 2020. Acute coronary syndromes were excluded. Since patients were not randomized toward MB or RA, potential confounding factors were taken into account using the propensity score methods. Thereby, inverse probability weighting was applied.
RESULTS
Ten thousand.ninety-twopatients underwent RA with an increasing trend from 1817 in 2017 toward 3166 in 2020. MBs were used in 22,378 patients also with an increasing trend from 4771 in 2017 toward 6078 in 2020. Patients receiving RA were older (74.23 ± 8.68 vs. 71.86 ± 10.02, p < 0.001), had a higher Charlson Comorbidity Index (2.07 ± 1.75 vs. 1.99 ± 1.76, p = 0.001) and more frequently left main (17.96% vs. 12.91%, p < 0.001) or three vessel disease (66.25% vs. 58.10%, p < 0.001). Adjusted procedural risk of major adverse cardiac and cerebrovascular events (MACCE) was similar in both groups, while pericardial effusion (RR 2.69; 95% CI 1.88-3.86, p < 0.001), pericardial puncture/pericardiotomy/pericardial tamponade (RR 2.66; 95% CI 1.85-3.81, p < 0.001) and bleeding (RR 1.65; 95% CI 1.12-2.43, p < 0.011) occurred more frequently in patients receiving RA. Patients treated with RA at high volume centers were hospitalized shorter (p = 0.005) and had a lower rate of acute cerebrovascular events (p < 0.001). Rate of MACCE, bleeding and pericardial puncture were not influenced by the annual RA numbers per center.
CONCLUSION
MBs had a lower risk of bleeding and pericardial puncture. Patients treated at centers with high annual RA procedure numbers had a lower risk of acute cerebrovascular events and were hospitalized shorter.
背景
改良球囊（MB）和旋磨术（RA）是治疗伴有浅表钙化的冠状动脉斑块的推荐工具。关于院内安全性的知识有限。
方法
通过2017年至2020年的国际疾病分类（ICD）和德国医疗程序统计（OPS）代码，识别在德国接受RA或MB血管成形术冠状动脉造影的冠心病患者。排除急性冠状动脉综合征。由于患者未随机分配至MB或RA组，因此使用倾向评分方法考虑潜在混杂因素。从而应用逆概率加权法。
结果
10092例患者接受了RA治疗，从2017年的1817例呈上升趋势至2020年的3166例。22378例患者使用了MB，也从2017年的4771例呈上升趋势至2020年的6078例。接受RA治疗的患者年龄更大（74.23±8.68岁对71.86±10.02岁，p<0.001），Charlson合并症指数更高（2.07±1.75对1.99±1.76，p = 0.001），更常出现左主干病变（17.96%对12.91%，p<0.001）或三支血管病变（66.25%对58.10%，p<0.001）。两组主要不良心脑血管事件（MACCE）的调整后手术风险相似，而接受RA治疗的患者心包积液（相对风险2.69；95%置信区间1.88 - 3.86，p<0.001）、心包穿刺/心包切开术/心包填塞（相对风险2.66；95%置信区间1.85 - 3.81，p<0.001）和出血（相对风险1.65；95%置信区间1.12 - 2.43，p<0.011）更频繁发生。在高容量中心接受RA治疗的患者住院时间更短（p = 0.005），急性脑血管事件发生率更低（p<0.001）。MACCE、出血和心包穿刺的发生率不受每个中心每年RA例数的影响。
结论
MB出血和心包穿刺风险较低。每年进行RA手术例数多的中心治疗的患者急性脑血管事件风险较低，住院时间更短。
Zotero 插件