Causes of Mortality After Percutaneous Coronary Intervention Insights From the VA Clinical Assessment, Reporting, and Tracking Program
Causes of Mortality After Percutaneous Coronary Intervention Insights From the VA Clinical Assessment, Reporting, and Tracking Program
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DOI：
10.1161/circoutcomes.118.005355
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发表时间：
2019-05-01
影响因子：
6.9
通讯作者：
Waldo, Stephen W.
中科院分区：
文献类型：
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作者：
Bricker, Rory S.;Valle, Javier A.;Waldo, Stephen W.
背景：经皮冠状动脉介入治疗 (PCI) 的公开报告经常使用围手术期（30 天）死亡率作为手术质量的替代指标，但尚不清楚死亡有多少频率归因于 PCI。由此评估了国家医疗保健系统中 PCI 30 天内死亡患者的死因。方法和结果：我们确定了 2005 年 10 月至 2016 年 9 月期间在退伍军人事务部 (VA) 医疗系统中接受 PCI 后 30 天内死亡的所有患者。通过使用学术研究联盟的定义进行详细图表审查，对死因进行了分类。在研究期间接受 PCI 的 115 191 名患者中，有 1674 名患者在 PCI 后 30 天内死亡（1.5%）。详细的图表审查表明，大多数患者的未分化死亡不能明确归因于单一原因（981 例，59%），而少数患者的死亡可直接归因于心血管原因（467 例，28%）。大多数心血管死亡与介入手术无关（335 例，72%）。与非心脏死亡（89%）或未分化死亡（49%，P<0.001）相比，住院患者更容易发生心血管死亡（95%）。结论：经皮血运重建术后发生的少数死亡肯定是由于心脏原因造成的，与 PCI 相关的死亡比例更小。由于直接归因于 PCI 的死亡比例如此之小，这些数据表明 30 天死亡率可能不是评估手术质量的适当指标。
BACKGROUND: Public reporting of percutaneous coronary intervention (PCI) often uses periprocedural (30 days) mortality as a surrogate for procedural quality, though it is unclear how often death is attributable to the PCI. The cause of death among patients who died within 30 days of PCI in a national healthcare system was thus evaluated. METHODS AND RESULTS: We identified all patients who died within 30 days of PCI in the Veterans Affairs (VA) Healthcare System from October 2005 to September 2016. Causes of death were classified through a detailed chart review using definitions from the Academic Research Consortium. Of 115 191 patients undergoing PCI during the study period, 1674 patients died within 30 days of PCI (1.5%). A detailed chart review demonstrated that the majority of patients had an undifferentiated death not definitively attributable to a single cause (981, 59%), whereas a minority had a death directly attributable to a cardiovascular cause (467, 28%). The majority of cardiovascular deaths were unrelated to the interventional procedure (335, 72%). Cardiovascular deaths were more likely to occur in the inpatient setting (95%) compared with noncardiac (89%) or undifferentiated deaths (49%, P< 0.001). CONCLUSIONS: A minority of deaths occurring after percutaneous revascularization were definitively due to cardiac causes, with an even smaller proportion related to the PCI. With such a small proportion of deaths directly attributable to the PCI, these data suggest that 30-day mortality may be an inappropriate metric to assess procedural quality.