Henderson R A, Raskino C L, Hampton J R
Department of Cardiology, Wythenshawe Hospital, Manchester, UK.
QJM. 1995 Mar;88(3):167-73.
The Randomised Intervention Treatment of Angina (RITA) trial is comparing the effects of coronary artery bypass surgery and coronary angioplasty. During patient recruitment, the trial participants maintained a register of patients investigated by coronary arteriography. We used the register data to analyse variation in the practice and therapeutic implications of coronary arteriography between the 17 participating centres. Of 33,359 patients undergoing coronary arteriography, 85.2% had significant coronary artery disease (range 81.3%-89.3% between centres). The planned management for patients with coronary disease included coronary bypass surgery (43.3%), coronary angioplasty (15.7%) and RITA randomization (3.2%). The rate of referral for myocardial revascularization varied between centres from 47.6% to 83.4%. Multiple logistic regression analysis identified several correlates of myocardial revascularization, including the indication for investigation, extent of coronary disease and left ventricular function. After adjustment for these variables, the odds of revascularization at the different participating centres varied by a factor of 4.2. This intercentre variation in the use of revascularization procedures may reflect variation in the clinician's view of the appropriateness of myocardial revascularization in different clinical circumstances.
心绞痛随机干预治疗（RITA）试验正在比较冠状动脉搭桥手术和冠状动脉血管成形术的效果。在患者招募期间，试验参与者维护了一份接受冠状动脉造影检查患者的登记册。我们使用登记册数据来分析17个参与中心之间冠状动脉造影操作的差异及其治疗意义。在33359例接受冠状动脉造影的患者中，85.2%患有严重冠状动脉疾病（各中心范围为81.3% - 89.3%）。冠心病患者的计划治疗包括冠状动脉搭桥手术（43.3%）、冠状动脉血管成形术（15.7%）和RITA随机分组（3.2%）。心肌血运重建的转诊率在各中心之间为47.6%至83.4%。多元逻辑回归分析确定了心肌血运重建的几个相关因素，包括检查指征、冠状动脉疾病程度和左心室功能。在对这些变量进行调整后，不同参与中心进行血运重建的几率相差4.2倍。血运重建程序使用方面的这种中心间差异可能反映了临床医生对不同临床情况下心肌血运重建适宜性看法的差异。
