Effects of hospital volume of primary percutaneous coronary interventions on angiographic results and in-hospital outcomes for acute myocardial infarction
Effects of hospital volume of primary percutaneous coronary interventions on angiographic results and in-hospital outcomes for acute myocardial infarction
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DOI：
10.1253/circj.72.1041
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发表时间：
2008-07-01
影响因子：
3.3
通讯作者：
Matsubara, Hiroaki
中科院分区：
文献类型：
--
作者：
Shiraishi, Jun;Kohno, Yoshio;Matsubara, Hiroaki
一些临床研究已经证明了直接经皮冠状动脉介入治疗（PCI）的住院量和住院死亡率之间的负相关关系。然而，在医院的主要PCI量，血管造影结果，并在急性心肌梗死（AMI）患者的医院预后之间的关系还没有得到充分的调查，在Japanes.Methods和结果使用AMI-京都多中心风险研究数据库之间的2000年1月和2005年12月，医院被分为五分之一的基础上，他们每年的主要PCI量。第五个五分之一的医院被标记为高容量，其他五分之一被合并并定义为低容量。尽管在高容量医院接受直接PCI的患者与低流量医院相比，高流量组（n=764）在首次冠状动脉造影时有更多的病变血管，PCI前梗死相关动脉的TIMI血流分级较低低流量组，n = 1，021），高流量组PCI术后即刻达到TIMI血流3级的比率显著高于低流量组。两组的总体住院死亡率无差异。多因素分析显示，在接受直接PCI的AMI患者中，入院时Killip分级≥ 3级、多支血管病变或左主干（LMT）为罪犯病变、病变血管数量≥ 2支或病变LMT以及年龄是院内死亡率的独立阳性预测因素，而直接PCI后TIMI血流3级和经过时间
Background Several clinical studies have demonstrated an inverse relationship between hospital volume of primary percutaneous coronary interventions (PCI) and in-hospital mortality. However, the relationships among hospital primary PCI volume, angiographic results, and in-hospital prognosis in patients with acute myocardial infarction (AMI) have not been fully investigated in Japan.Methods and Results Using the AMI-Kyoto Multi-Center Risk Study database between January 2000 and December 2005, hospitals were classified into quintiles based on their annual volume of primary PCI. The fifth quintile of hospitals was labeled as high-volume, and the other quintiles were combined and defined as low-volume. Although patients undergoing primary PCI in high-volume hospitals (high-volume group, n=764) had a larger number of diseased vessels at initial coronary angiography and lower Thrombolysis In Myocardial Infarction (TIMI) flow grade in the infarct-related artery before PCI, compared with those in low-volume hospitals (low-volume group, n = 1,021), the rates of achieving TIMI flow grade 3 just after PCI in the high-volume group was significantly higher than that in the low-volume group. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class >= 3 at admission, multivessel disease or left main trunk (LMT) as culprit lesion, number of diseased vessels >= 2 or diseased LMT, and age were the independent positive predictors of in-hospital mortality, whereas the TIMI flow grade 3 after primary PCI and elapsed time