Surgical Candidacy and Selection Biases in Nonemergent Left Main Stenting Implications for Observational Studies
Surgical Candidacy and Selection Biases in Nonemergent Left Main Stenting Implications for Observational Studies
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DOI：
10.1016/j.jcin.2011.06.010
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发表时间：
2011-09-01
影响因子：
11.3
通讯作者：
Lundstrom, Robert J.
中科院分区：
文献类型：
--
作者：
McNulty, Edward J.;Ng, William;Lundstrom, Robert J.
目的本研究旨在描述非急诊无保护左主干（乌尔姆）经皮冠状动脉介入治疗（PCI）患者不适合手术的原因，并评估这些原因混淆冠状动脉血运重建的比较有效性研究的可能性。背景尽管PCI和冠状动脉旁路移植术都是乌尔姆疾病的治疗方法，但有些患者不适合两种治疗方法，方法在101例接受非急诊乌尔姆PCI的连续患者中，采用混合方法来确定手术不合格决定的治疗选择的流行率，并确定避免冠状动脉旁路移植术的原因。然后，我们确定这些原因是否被ACC-NCDR（美国心脏病学会-国家心血管数据登记处）Cath-PCI数据集捕获，以评估该登记处解释治疗选择偏倚的能力。最后，手术资格与长期预后后乌尔姆PCI assessed.Results治疗的选择是由手术不合格超过一半的乌尔姆PCI队列与大多数的原因不合格的ACC-NCDR捕获。经胸外科医师协会校正后，手术不合格是死亡率的重要预测因素（风险比[HR]：5.4，95%置信区间[CI]：1.2 - 25），EuroSCORE（欧洲心脏手术风险评估系统）（HR：5.9，95% CI：1.3 - 27）或NCDR死亡率评分（HR：6.2，95% CI：结论在非急诊乌尔姆PCI患者中，决定治疗选择的手术不合格是常见的，发生在ACC-NCDR未捕获的风险因素的基础上，并且在调整标准风险评分后与更差的长期结局独立相关。（J Am科尔Cardiol Intv 2011;4：1020-7）（C）美国心脏病学会基金会2011年
Objectives This study sought to characterize reasons for surgical ineligibility in patients undergoing nonemergent unprotected left main (ULM) percutaneous coronary intervention (PCI) and to assess the potential for these reasons to confound comparative effectiveness studies of coronary revascularization.Background Although both PCI and coronary artery bypass graft surgery are treatments for ULM disease, some patients are not eligible for both treatments, which may result in treatment selection biases.Methods In 101 consecutive patients undergoing nonemergent ULM PCI, mixed methods were used to determine the prevalence of treatment selection dictated by surgical ineligibility and to identify the reasons cited for avoiding coronary artery bypass graft surgery. We then determined whether these reasons were captured by the ACC-NCDR (American College of Cardiology-National Cardiovascular Data Registry) Cath-PCI dataset to assess the ability of this registry to account for biases in treatment selection. Finally, the association of surgical eligibility with long-term outcomes after ULM PCI was assessed.Results Treatment selection was dictated by surgical ineligibility in over half the ULM PCI cohort with the majority having reasons for ineligibility not captured by the ACC-NCDR. Surgical ineligibility was a significant predictor of mortality after adjustment for Society of Thoracic Surgeons (hazard ratio [HR]: 5.4, 95% confidence interval [CI]: 1.2 to 25), EuroSCORE (European System for Cardiac Operative Risk Evaluation) (HR: 5.9, 95% CI: 1.3 to 27), or NCDR mortality scores (HR: 6.2, 95% CI: 1.4 to 27).Conclusions Surgical ineligibility dictating treatment selection is common in patients undergoing nonemergent ULM PCI, occurs on the basis of risk factors not captured by the ACC-NCDR, and is independently associated with worse long-term outcomes after adjusting for standard risk scores. (J Am Coll Cardiol Intv 2011;4:1020-7) (C) 2011 by the American College of Cardiology Foundation