Utilization of catheterization and revascularization procedures in patients with non-ST segment elevation acute coronary syndrome over the last decade
Utilization of catheterization and revascularization procedures in patients with non-ST segment elevation acute coronary syndrome over the last decade
复制标题
DOI：
10.1002/ccd.20469
复制
发表时间：
2005-10-01
影响因子：
2.3
通讯作者：
Fox, KAA
中科院分区：
文献类型：
--
作者：
Levine, GN;Lincoff, AM;Fox, KAA
非ST段抬高急性冠脉综合征（NSTE-ACS）患者住院期间使用导管插入术和血运重建术的程度对初始药物治疗决策（前期治疗）、治疗和医院转移方案、指南建议以及培训、材料和财务资源的分配具有广泛的影响。对NSTE-ACS患者的多项试验和登记研究的数据进行分析，有可能更广泛地评估侵入性和血运重建手术的使用情况，并提供此类患者管理的广角或鸟瞰图，补充从任何一项试验或登记研究中获得的数据。因此，我们对过去十年中进行的所有NSTE-ACS患者的大型试验和登记研究进行了系统性概述，认为这些试验和登记研究适合提供导管插入术和血运重建术的信息。尽管在不同的临床试验和登记研究中，接受心导管插入术、经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术治疗的NSTE-ACS患者的百分比有所不同，但这些研究仍然可以看出一般结果和趋势。在初始治疗期间，大多数患者最终仅接受药物治疗（例如，不进行血管重建）。在过去的十年中，接受诊断性心导管插入术的NSTE-ACS患者接受PCI治疗的比例增加，目前约为50%。在接受血运重建的NSTE-ACS患者中，通过PCI进行血运重建的患者百分比也同样增加，PCI是目前约四分之三接受血运重建的患者中使用的血运重建手术。与非美国研究受试者队列相比，美国研究受试者队列中接受侵入性和血运重建手术的患者百分比始终较高。(c)，2005 Wiley-Liss，Inc.
The degree to which catheterization and revascularization procedures are utilized in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) during hospitalization has broad implications with respect to initial pharmacotherapeutic decisions (upfront therapies), treatment and hospital transfer protocols, guideline recommendations, and allocation of training, material, and financial resources. Analysis of data from multiple trials and registries of patients with NSTE-ACS has the potential to assess more broadly utilization of invasive and revascularization procedures and provide a wide angle or bird's-eye view of the management of such patients, complementing the data obtained from any one trial or registry. We therefore undertook a systematic overview of all large trials and registries of patients with NSTE-ACS conducted over the last decade that were deemed appropriate to provide information on catheterization and revascularization procedures. Although not unexpectedly the percentage of patients with NSTE-ACS managed with cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting varies in different clinical trials and registries, general findings and trends were still discernable from these studies. During the initial treatment period, the majority of patients were ultimately treated with medical therapy alone (e.g., without revascularization). The percentage of those NSTE-ACS patients undergoing diagnostic cardiac catheterization who were then managed with PCI increased over the last decade and now stands at approximately 50%. Of NSTE-ACS patients who undergo revascularization, the percentage of those patients who are revascularized via PCI similarly increased, and PCI is currently the revascularization procedure utilized in approximately three-fourths of patients undergoing revascularization. The percentages of patients undergoing invasive and revascularization procedures were consistently higher in the U.S. cohorts of study subjects when compared to non-U.S. cohorts of study subjects. (c), 2005 Wiley-Liss, Inc.