Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: A matched analysis using propensity scores
Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: A matched analysis using propensity scores
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DOI：
10.1016/s0895-4356(00)00321-8
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发表时间：
2001-04-01
影响因子：
7.2
通讯作者：
McNeil, BJ
中科院分区：
文献类型：
--
作者：
Normand, SLT;Landrum, NB;McNeil, BJ
我们确定急性心肌梗死（AMI）后症状发作后超过12小时但出院前坚持冠状动脉造影的建议是否会导致更好的生存率。使用倾向评分法，我们对1994-1995年间在美国因AMI住院的19,568名医疗保险患者进行了匹配的回顾性样本。分别有29%、36%和34%的患者被认为有必要、适当或不确定进行血管造影，而60%的被认为有必要的患者在住院期间接受了血管造影。3年生存获益最大的是被评定为必要的患者[平均生存差异（95% CI）：17.6%（15.1，20.1）]，最小的是被评定为不确定的患者[8.8%（6.8，10.7）]。血管造影建议似乎选择了可能从手术和后续干预中受益的患者。由于受益的程度和涉及的患者数量，应采取措施复制这些发现。(C)2001 Elsevier Science Inc. All rights reserved.
We determined whether adherence to recommendations for coronary angiography more than 12 h after symptom onset but prior to hospital discharge after acute myocardial infarction (AMI) resulted in better survival. Using propensity scores, we created a matched retrospective sample of 19,568 Medicare patients hospitalized with AMI during 1994-1995 in the United States. Twenty-nine percent, 36%, and 34% of patients were judged necessary, appropriate, or uncertain, respectively, for angiography while 60% of those judged necessary received the procedure during the hospitalization. The 3-year survival benefit was largest for patients rated necessary [mean survival difference (95% CI): 17.6% (15.1, 20.1)] and smallest for those rated uncertain [8.8% (6.8, 10.7)]. Angiography recommendations appear to select patients who are likely to benefit from the procedure and the consequent interventions. Because of the magnitude of the benefit and of the number of patients involved, steps should be taken to replicate these findings. (C) 2001 Elsevier Science Inc. All rights reserved.