The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR): building a national clinical data repository.
The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR): building a national clinical data repository.
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DOI：
10.1016/s0735-1097(01)01372-9
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发表时间：
2001-06-15
影响因子：
24
通讯作者：
Williams, J F
中科院分区：
文献类型：
--
作者：
Brindis, R G;Fitzgerald, S;Williams, J F
诊断性心导管和经皮冠状动脉介入治疗（pci）是冠状动脉疾病患者诊断和治疗的关键组成部分。随着老龄化人口中心脏病患病率的增加以及冠状动脉疾病治疗的侵入性方法的发展，每年进行的心导管插入术的数量继续上升。在美国，1997年估计有119.4万名住院患者进行了心导管插入术，同时有近50万例pci(1)。自Andreas Gruentzig完成首例人类血管成形术以来，PCI迅速发展成为冠状动脉疾病患者实现心肌血运重建术的一种非常成功的策略。目前PCI的死亡率已降至1%的一小部分。PCI手术相关并发症导致心肌梗死或紧急冠状动脉搭桥手术的数量已大幅下降至3%以下(2)。在介入心脏病学的第二个十年结束时，PCI冠状动脉内支架植入术已经占据了中心位置。1993年至1997年间，支架变得普遍，导致手术成功率提高，住院并发症发生率降低，再狭窄率降低。随着新器械和药物治疗的出现，PCI相关不良后果的风险进一步降低。常规球囊血管成形术的手术成功率和并发症发生率随着定向冠状动脉粥样硬化切除术、旋转动脉粥样硬化切除术、提取动脉粥样硬化切除术和其他所谓的导管装置的引入而提高。现在正在引入新的导管装置，如过滤系统和远端闭塞/抽吸系统。这些装置有助于最大限度地减少在病变隐静脉移植物行PCI时发生的术中心肌梗死，这种心肌梗死与冠状动脉远端栓塞碎片的释放有关。PCI的主要缺点是不可接受的再狭窄率，目前正在采用新开发的治疗方法，如冠状动脉近距离放疗和化疗洗脱支架的使用。24年来，大规模的登记和数据库被用于积累PCI的数据，并且在较小程度上用于心导管插入术(3)。这些登记已被用于研究患者和手术特征、术后治疗、即时住院结果和长期结果。为了提高冠心病患者的治疗质量，对这些数据进行了许多不同的分析。质量的提高主要是通过更好地理解PCI的风险和益处，无论是对全球特定患者群体还是对个体患者手术风险分层。这项工作对最初的球囊血管成形术至关重要，更重要的是对新设备的引入和PCI在心肌梗死中的作用。
Diagnostic cardiac catheterization and percutaneous coronary interventions (PCIs) are critical components of the diagnosis and treatment of patients with coronary artery disease. As the prevalence of heart disease increases in our aging population and increasingly aggressive invasive approaches are developed for the treatment of coronary artery disease, the number of cardiac catheterization procedures performed yearly continues to rise. In the US, an estimated 1,194,000 in-patient cardiac catheterizations were performed in 1997 along with nearly 500,000 PCIs (1). Since Andreas Gruentzig performed the first human angioplasty, PCI has rapidly evolved to be a highly successful strategy for achieving myocardial revascularization in patients with coronary artery disease. The PCI mortality rate has decreased in the present era to a fraction of 1%. The number of PCI procedure-related complications leading to myocardial infarction or emergent coronary artery bypass graft surgery has decreased considerably to fewer than 3% each (2). Intracoronary stenting with PCI has taken center stage at the end of the second decade of interventional cardiology. Between 1993 and 1997, stents became commonplace, leading to improved procedural success rates, decreased in-hospital complication rates, and decreased restenosis rates. With the advent of new devices and pharmacological therapies, the risk of adverse outcomes associated with PCI has further decreased. Procedural success rates and complication rates of conventional balloon angioplasty have improved with the introduction of directional coronary atherectomy, rotational atherectomy, extraction atherectomy, and other so-called niche catheter devices. New catheter devices such as filter systems and distal occlusion/aspiration systems are now being introduced. These devices help to minimize periprocedural myocardial infarctions that occur during PCI performed in diseased saphenous vein grafts associated with the release of embolic debris distally in the coronary vasculature. The major drawback of PCI, an unacceptable restenosis rate, is presently being approached with newly developing treatments such as coronary brachytherapy and the use of chemotherapy-eluting stents. For more than 24 years, large-scale registries and databases have been used to accumulate data on PCI and, to a lesser extent, cardiac catheterizations (3). These registries have been used to study patient and procedural characteristics, post-procedure treatments, immediate in-hospital outcomes, and long-term outcomes. Many different analyses of these data have been performed in an effort to improve the quality of care that coronary patients receive. Quality improvements have come about primarily through a greater understanding of the risks and benefits of PCI, both globally for given patient populations and individually for patient procedure risk stratification. This effort has been critical for the original balloon angioplasty procedure and more importantly for the introduction of new devices and the role of PCI in myocardial infarction.