Kimmel S E, Berlin J A, Hennessy S, Strom B L, Krone R J, Laskey W K
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
J Am Coll Cardiol. 1997 Jul;30(1):193-200. doi: 10.1016/s0735-1097(97)00149-6.
This study was designed to determine the risk of performing percutaneous transluminal coronary angioplasty (PTCA) at the time of diagnostic catheterization ("combined procedures").
Health care providers are under increasing pressure to combine diagnostic and interventional coronary procedures to reduce costs. However, the risk associated with combined procedures has not been rigorously assessed.
A multicenter cohort study of 35,700 patients undergoing elective PTCA from 1992 through 1995 was performed to determine the risk of major complications (myocardial infarction, emergency coronary artery bypass graft surgery or death) from combined relative to staged procedures (i.e., performing PTCA at a session subsequent to diagnostic catheterization).
The risks of major complications from combined and staged procedures were 2.0% and 1.6%, respectively (unadjusted odds ratio [OR] 1.28, 95% confidence interval [CI] 1.05 to 1.57). After adjusting for clinical and angiographic differences and clustering by laboratory, the risk from combined procedures was not significantly elevated (multivariable OR 1.18, 95% CI 0.89 to 1.55). However, several subgroups of patients did have an increased risk from combined procedures: patients with multivessel disease (multivariable OR 1.64, 95% CI 1.13 to 2.39); women (multivariable OR 1.64, 95% CI 1.05 to 2.55); patients > 65 years old (multivariable OR 1.40, 5% CI 1.02 to 1.93); and patients undergoing multilesion PTCA (multivariable OR 1.53, 95% CI 1.06 to 2.21). The risk of combined relative to staged procedures decreased over the 4-year period (multivariable p = 0.029).
Combining PTCA with diagnostic catheterization appears to be safe in many patients. However, several subgroups of patients may be at increased risk. Careful patient selection will most likely remain critical to ensuring the safety of combined procedures.
本研究旨在确定在诊断性心导管插入术时进行经皮腔内冠状动脉成形术（PTCA）（“联合手术”）的风险。
医疗服务提供者面临着越来越大的压力，要将诊断性和介入性冠状动脉手术相结合以降低成本。然而，联合手术相关的风险尚未得到严格评估。
对1992年至1995年期间接受择期PTCA的35700例患者进行了一项多中心队列研究，以确定联合手术相对于分期手术（即在诊断性心导管插入术后的另一时段进行PTCA）发生主要并发症（心肌梗死、急诊冠状动脉搭桥手术或死亡）的风险。
联合手术和分期手术的主要并发症风险分别为2.0%和1.6%（未调整优势比[OR]为1.28，95%置信区间[CI]为1.05至1.57）。在对临床和血管造影差异进行调整并按实验室进行聚类分析后，联合手术的风险并未显著升高（多变量OR为1.18，95%CI为0.89至1.55）。然而，有几个患者亚组联合手术的风险确实增加：多支血管病变患者（多变量OR为1.64，95%CI为1.13至2.39）；女性（多变量OR为1.64，95%CI为1.05至2.55）；65岁以上患者（多变量OR为1.40，95%CI为1.02至1.93）；以及接受多病变PTCA的患者（多变量OR为1.53，95%CI为1.06至2.21）。联合手术相对于分期手术的风险在4年期间有所降低（多变量p = 0.029）。
在许多患者中，将PTCA与诊断性心导管插入术相结合似乎是安全的。然而，有几个患者亚组可能风险增加。仔细的患者选择对于确保联合手术的安全性很可能仍然至关重要。
