Mogensen J, Bille S, Toftegaard-Nielsen T
Hjertemedicinsk afdeling B, Skejby Sygehus, Arhus.
Ugeskr Laeger. 1996 Jun 24;158(26):3768-72.
It was the aim to reduce deaths among future patients queuing for heart catheterization or surgery. All the patients who died, after they were referred for heart catheterization or surgery because of coronary heart and heart valve disease, were registered over a three year period (July 1, 1990 to June 30, 1993). The total number of deaths was 98. Ninety-two (94%) died of cardiac disease. Seventyfour (80%) only had symptoms of cardiac disease; ten (11%) had competitive disease and eight (9%) had received revascularizing treatment previously. The number of catheterizations increased from 968 to 1312 per year, while the number of operations remained constant at about 600 per year. The death-rate for patients referred to heart catheterization was 2.5% for patients with aortic valve disease and 1.7% for patients with coronary heart disease. For patients referred for coronary artery bypass grafting the death-rate was 2.6% and for heart valve surgery 3.9%. The survival-time for patients waiting for catheterization was 4.2 months (0.3-16) and 4 months (1-16) for patients waiting for surgery. Half of the deaths in patients queuing for cardiac catheterization occurred within one month of waiting while half of the deaths in patients waiting for heart surgery appeared within 1.3 months. In the early deaths among patients queuing for cardiac catheterization there was a tendency towards prolonged doctor's delay and a surplus of patients with aortic valve disease. Deaths among patients awaiting heart catheterization or surgery can hardly be avoided. However, in the present study the death-rates for patients referred to surgery was 1.8 to 7.7 times higher compared to the conditions in other Western countries. The waiting-time was long and cardiac deaths frequent, reflecting the low capacity for invasive procedures as well as operations during this period.
目标是减少未来排队等待心脏导管插入术或手术的患者的死亡人数。所有因冠心病和心脏瓣膜疾病被转诊进行心脏导管插入术或手术之后死亡的患者，在三年期间（1990年7月1日至1993年6月30日）进行了登记。死亡总数为98人。92人（94%）死于心脏病。74人（80%）仅有心脏病症状；10人（11%）患有竞争性疾病，8人（9%）此前接受过血管重建治疗。每年的导管插入术数量从968例增加到1312例，而手术数量保持不变，每年约600例。接受心脏导管插入术的患者中，主动脉瓣疾病患者的死亡率为2.5%，冠心病患者为1.7%。接受冠状动脉搭桥术的患者死亡率为2.6%，心脏瓣膜手术患者为3.9%。等待导管插入术的患者的生存时间为4.2个月（0.3 - 16个月），等待手术的患者为4个月（1 - 16个月）。排队等待心脏导管插入术的患者中，一半的死亡发生在等待的一个月内，而等待心脏手术的患者中，一半的死亡出现在1.3个月内。在排队等待心脏导管插入术的患者的早期死亡中，存在医生延误时间延长的趋势，且主动脉瓣疾病患者过多。等待心脏导管插入术或手术的患者死亡几乎难以避免。然而，在本研究中，与其他西方国家的情况相比，接受手术的患者的死亡率高出1.8至7.7倍。等待时间长且心脏死亡频繁，反映出这一时期侵入性操作以及手术的能力较低。
