Change in hospital-level use of transradial percutaneous coronary intervention and periprocedural outcomes: insights from the national cardiovascular data registry.
Change in hospital-level use of transradial percutaneous coronary intervention and periprocedural outcomes: insights from the national cardiovascular data registry.
复制标题
医院层面经桡动脉经皮冠状动脉介入治疗的使用和围手术期结果的变化：来自国家心血管数据登记处的见解。
DOI：
10.1161/circoutcomes.114.001020
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Gurm,HitinderS
中科院分区：
文献类型：
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作者：
Bradley,StevenM;Rao,SunilV;Curtis,JepthaP;Parzynski,CraigS;Messenger,JohnC;Daugherty,StacieL;Rumsfeld,JohnS;Gurm,HitinderS
背景桡动脉入路的增加是否改善了经皮冠状动脉介入治疗的结果仍不清楚。我们试图确定经桡动脉经皮冠状动脉介入治疗（TRI）和围手术期结局之间的关系，方法和结果在国家心血管数据注册中心CathPCI注册中心，我们估计了TRI使用变化的医院类别之间的风险调整相关性。（2009年至2012年3年期间）以及818家基线TRI使用率较低的机构的穿刺部位和总体出血、透视时间和造影剂使用的趋势。TRI用途：医院变化分为4类：极低（基线时0.2%增加至3年结束时的1.8%）、低（0.9%增加至8.9%）、中度（1.6%增加至27.2%）和高（1.0%增加至45.1%）。所有医院类别中，经风险调整的穿刺部位出血均随时间推移而下降;然而，不同医院类别的下降率不同（相互作用P <0.001）。TRI使用中度或高度增加的医院（相对风险，0.45，95%置信区间，0.36-0.56）的穿刺部位出血减少率显著高于极低或低TRI使用的医院（相对风险，0.65; 95%置信区间，0.58-0.74; P比较，0.002）。观察到总体出血的相似结果。在中度和高度使用TRI的医院，透视时间增加（1.3分钟）（P=0.01）。对比剂使用的趋势是相似的医院category.ConclusionsIn一个国家样本的医院进行经皮冠状动脉介入治疗，出血率随着时间的推移下降的所有医院类别的TRI使用的变化。与TRI使用变化最小或无变化的医院相比，TRI使用增加的医院出血结局下降幅度更大。
BackgroundWhether increasing use of radial access has improved percutaneous coronary intervention outcomes remains unknown. We sought to determine the relationship between increasing facility-level use of transradial percutaneous coronary intervention (TRI) and periprocedural outcomes.Methods and ResultsWithin the National Cardiovascular Data Registry CathPCI Registry, we estimated the risk-adjusted association between hospital category of change in TRI use (during the 3-year period from 2009 to 2012) and trends in access site and overall bleeding, fluoroscopy time, and contrast use among 818 facilities with low baseline TRI use. There were 4 categories of hospital change in TRI use: very low (baseline, 0.2% increasing to 1.8% at the end of 3 years), low (0.9% increasing to 8.9%), moderate (1.6% increasing to 27.2%), and high (1.0% increasing to 45.1%). Risk-adjusted access site bleeding decreased over time for all hospital categories; however, the rate of decline varied across hospital categories (Pfor interaction, <0.001). The decrease in access site bleeding was significantly greater for hospitals with moderate or high increases in TRI use (relative risk, 0.45, 95% confidence interval, 0.36–0.56) when compared with that of very low or low hospitals (relative risk, 0.65; 95% confidence interval, 0.58–0.74;Pfor comparison, 0.002). Similar findings were observed for overall bleeding. An increase in fluoroscopy time (≈1.3 minutes) was noted at hospitals with moderate and high use of TRI (P=0.01). Trends in contrast use were similar across hospital categories.ConclusionsIn a national sample of hospitals performing percutaneous coronary intervention, bleeding rates decreased over time for all hospital categories of change in TRI use. The decline in bleeding outcomes was larger at hospitals with increased adoption of TRI when compared with hospitals with minimal or no change in TRI use.