The volume of primary angioplasty procedures and survival after acute myocardial infarction
The volume of primary angioplasty procedures and survival after acute myocardial infarction
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DOI：
10.1056/nejm200005253422106
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发表时间：
2000-05-25
影响因子：
158.5
通讯作者：
Barron, HV
中科院分区：
文献类型：
--
作者：
Canto, JG;Every, NR;Barron, HV
背景资料：由心血管原因引起的死亡率与个体医生或医院进行的择期心脏手术（冠状动脉血管成形术、支架植入术或冠状动脉旁路手术）的数量呈反比关系。然而，目前尚不清楚急性心肌梗死患者是否更好地在中心，更多的患者接受初级血管成形术或溶栓治疗比中心低volumes.Methods：我们分析了数据从国家心肌梗死登记处，以确定接受再灌注治疗（初级血管成形术或溶栓治疗）和随后的住院死亡率的患者数量之间的关系。共450家医院根据初次血管成形术的数量分为四分位数。采用多元逻辑回归模型来确定初次血管成形术的手术量是否是接受该手术的患者住院死亡率的独立预测因素。对516家医院接受溶栓治疗的患者进行了类似的分析。结果：在容量最大的医院接受直接血管成形术的患者的院内死亡率比在容量最小的医院接受血管成形术的患者低28%（调整后的相对危险度为0.72; 95%置信区间为0.60至0.87; P
Background: There is an inverse relation between mortality from cardiovascular causes and the number of elective cardiac procedures (coronary angioplasty, stenting, or coronary bypass surgery) performed by individual practitioners or hospitals. However, it is not known whether patients with acute myocardial infarction fare better at centers where more patients undergo primary angioplasty or thrombolytic therapy than at centers with lower volumes.Methods: We analyzed data from the National Registry of Myocardial Infarction to determine the relation between the number of patients receiving reperfusion therapy (primary angioplasty or thrombolytic therapy) and subsequent in-hospital mortality. A total of 450 hospitals were divided into quartiles according to the volume of primary angioplasty. Multiple logistic-regression models were used to determine whether the volume of primary angioplasty procedures was an independent predictor of in-hospital mortality among patients undergoing this procedure. Similar analyses were performed for patients receiving thrombolytic therapy at 516 hospitals.Results: In-hospital mortality was 28 percent lower among patients who underwent primary angioplasty at hospitals with the highest volume than among those who underwent angioplasty at hospitals with the lowest volume (adjusted relative risk, 0.72; 95 percent confidence interval, 0.60 to 0.87; P