Appropriateness of percutaneous coronary intervention.
Appropriateness of percutaneous coronary intervention.
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DOI：
10.1001/jama.2011.916
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发表时间：
2011-07-06
影响因子：
120.7
通讯作者：
Spertus, John A.
中科院分区：
文献类型：
--
作者：
Chan, Paul S.;Patel, Manesh R.;Klein, Lloyd W.;Krone, Ronald J.;Dehmer, Gregory J.;Kennedy, Kevin;Nallamothu, Brahmajee K.;Weaver, W. Douglas;Masoudi, Frederick A.;Rumsfeld, John S.;Brindis, Ralph G.;Spertus, John A.
尽管经皮冠状动脉介入治疗（PCI）已广泛使用，但这些手术在当代实践中的适当性尚不清楚。评估PCI在美国的适用性。对2009年7月1日至2010年9月30日期间在1091家美国医院接受PCI的国家心血管数据注册中心患者进行的多中心、前瞻性研究。使用冠状动脉血运重建的适当使用标准裁定PCI的适当性。根据手术是否用于急性（ST段抬高型心肌梗死、非ST段抬高型心肌梗死或具有高危特征的不稳定型心绞痛）或非急性适应症对结果进行分层。急性和非急性PCI被分类为适当、不确定或不适当的比例;不适当手术的医院水平变化程度。在500 154例PCI中，355 417例（71.1%）用于急性适应症ST段抬高型心肌梗死103 245例（20.6%），非ST段抬高型心肌梗死105 708例（21.1%）;高危不稳定型心绞痛，146 464例[29.3%]）和144 737例（28.9%）非急性适应症。对于急性适应症，350469例PCI（98.6%）被归类为适当，1055例（0.3%）被归类为不确定，3893例（1.1%）被归类为不适当。对于非急性适应症，72 911例PCI（50.4%）被归类为适当，54 988例（38.0%）被归类为不确定，16 838例（11.6%）被归类为不适当。大多数非急性适应症的不适当PCI是在无心绞痛（53.8%）、无创负荷试验中低风险缺血（71.6%）或次优（≤1种药物）抗心绞痛治疗（95.8%）的患者中进行的。此外，尽管急性手术中不适当PCI的比例在医院间的差异很小，但非急性手术的医院差异很大（不适当PCI的中位住院率为10.8%;四分位数范围为6.0%-16.7%）。在这一大型当代美国队列中，几乎所有急性PCI均被归类为适当。然而，对于非急性适应症，12%被归类为不适当，各医院之间存在很大差异。
Despite the widespread use of percutaneous coronary intervention (PCI), the appropriateness of these procedures in contemporary practice is unknown. To assess the appropriateness of PCI in the United States. Multicenter, prospective study of patients within the National Cardiovascular Data Registry undergoing PCI between July 1, 2009, and September 30, 2010, at 1091 US hospitals. The appropriateness of PCI was adjudicated using the appropriate use criteria for coronary revascularization. Results were stratified by whether the procedure was performed for an acute (ST-segment elevation myocardial infarction, non–ST-segment elevation myocardial infarction, or unstable angina with high-risk features) or nonacute indication. Proportion of acute and nonacute PCIs classified as appropriate, uncertain, or inappropriate; extent of hospital-level variation in inappropriate procedures. Of 500 154 PCIs, 355 417 (71.1%) were for acute indications (ST-segment elevation myocardial infarction, 103 245 [20.6%]; non–ST-segment elevation myocardial infarction, 105 708 [21.1%]; high-risk unstable angina, 146 464 [29.3%]), and 144 737 (28.9%) for nonacute indications. For acute indications, 350 469 PCIs (98.6%) were classified as appropriate, 1055 (0.3%) as uncertain, and 3893 (1.1%) as inappropriate. For nonacute indications, 72 911 PCIs (50.4%) were classified as appropriate, 54 988 (38.0%) as uncertain, and 16 838 (11.6%) as inappropriate. The majority of inappropriate PCIs for nonacute indications were performed in patients with no angina (53.8%), low-risk ischemia on noninvasive stress testing (71.6%), or suboptimal (≤1 medication) antianginal therapy (95.8%). Furthermore, although variation in the proportion of inappropriate PCI across hospitals was minimal for acute procedures, there was substantial hospital variation for nonacute procedures (median hospital rate for inappropriate PCI, 10.8%; interquartile range, 6.0%–16.7%). In this large contemporary US cohort, nearly all acute PCIs were classified as appropriate. For nonacute indications, however, 12% were classified as inappropriate, with substantial variation across hospitals.
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影响因子：
11.3
作者：
Hannan, Edward L.;Samadashvili, Zaza;King, Spencer B., III
通讯作者：
King, Spencer B., III
影响因子：
3.5
作者：
Yim, J;Khang, YH;Kim, C
通讯作者：
Kim, C
DOI：
10.1016/s0735-1097(01)01372-9
发表时间：
2001-06-15
影响因子：
24
作者：
Brindis, R G;Fitzgerald, S;Williams, J F
通讯作者：
Williams, J F
影响因子：
120.7
作者：
HILBORNE, LH;LEAPE, LL;BROOK, RH
通讯作者：
BROOK, RH
影响因子：
--
作者：
Chan, Paul S.;Nichol, Graham;Nallamothu, Brahmajee K.
通讯作者：
Nallamothu, Brahmajee K.