The appropriateness of percutaneous transluminal coronary angioplasty in Korea
The appropriateness of percutaneous transluminal coronary angioplasty in Korea
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DOI：
10.1016/j.ijcard.2003.03.028
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发表时间：
2004-06-01
影响因子：
3.5
通讯作者：
Kim, C
中科院分区：
文献类型：
--
作者：
Yim, J;Khang, YH;Kim, C
背景：在韩国，经皮腔内冠状动脉成形术（PTCA）的迅速采用引起了人们对该手术在不适当适应症下可能过度使用的广泛关注。本研究旨在评估PTCA在韩国的适当应用率，并探讨影响该率的因素。方法：根据Delphi-RAND技术开发评估工具，由7名成员组成专家组（2名心脏外科医生、3名介入心脏病专家和2名内科医生），其成员对相互排斥的适应症进行评分。根据制定的适当性标准，分析了全国25家医院1228名PTCA患者的病历。结果：总体而言，13.2%的PTCA手术是合适的，3.7%的PTCA手术是不合适的。经诊断，急性心肌梗死患者用药适宜率最高，慢性稳定型心绞痛患者用药不适宜率最高。适当率与在医院进行的手术次数相关。在多变量分析中，诊断、风险、PTCA年度量、PTCA介入医师人数、介入医师国外培训经历与适宜性显著相关。结论：韩国的适宜率和不适宜率与PTCA引进较早、实施频率较高的国家相当。然而，在执行少数PTCA病例的医院的适当性应加以监测和改进。2003爱思唯尔爱尔兰有限公司版权所有。
Background: The rapid adoption of percutancous transluminal coronary angioplasty (PTCA) in Korea is provoking a widespread concern about possible overuse of this procedure with inappropriate indications. This study aimed to assess the rate of appropriate application of PTCA in Korea and investigate factors affecting this rate. Methods: An assessment tool was developed according to the Delphi-RAND technique, in which an expert panel of seven members (two cardiac surgeons, three interventional cardiologists, and two internists) was formed and its members rated mutually exclusive indications. Medical records of 1228 patients who underwent PTCA at 25 centers across Korea were analyzed based on the developed appropriateness criteria. Results: Overall, 13.2% of PTCA procedures were appropriate and 3.7% were inappropriate. By diagnoses, the rate of appropriateness was highest in acute myocardial infarction, and the rate of inappropriateness was highest in chronic stable angina. The appropriateness rate was correlated with the number of procedures performed at a hospital. In a multivariate analysis, diagnoses, risk, annual PTCA volume, number of PTCA interventionists, and interventionists' training experience in foreign countries were significantly correlated with the appropriateness. Conclusions: The appropriateness and inappropriateness rates in Korea are comparable to those in countries in which PTCA has been introduced earlier and performed more frequently. However, the appropriateness in hospitals performing a small number of PTCA cases should be monitored and improved. (C) 2003 Elsevier Ireland Ltd. All rights reserved.