Relationship Between Hospital Volume and Outcomes Following Primary Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction
Relationship Between Hospital Volume and Outcomes Following Primary Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction
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DOI：
10.1253/circj.cj-10-0556
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发表时间：
2011-05-01
影响因子：
3.3
通讯作者：
Matsuda, Shinya
中科院分区：
文献类型：
--
作者：
Kuwabara, Hiroyo;Fushimi, Kiyohide;Matsuda, Shinya
背景：直接经皮冠状动脉介入治疗(PCI)是急性心肌梗死(MI)患者的重要治疗选择。虽然西方研究发现医院的介入治疗数量与住院死亡率呈负相关，但日本以往的研究尚未发现这种关系。方法与结果：回顾分析2006年以来8391例急性心肌梗死患者的临床资料。主要结果是住院死亡率。根据每半年接受冠状动脉介入治疗的次数(6-13，14-22，23-38，39-134)，医院被分为四分位数，并比较了不同组的死亡率。最低四分位数的粗死亡率为7.0%，而最高四分位数的粗死亡率为4.9%。直接经皮冠状动脉介入治疗手术量与住院粗死亡率呈负相关(P=0.016)。调整病例组合后，与容量最低的医院相比，高容量医院(第3和第4四分位数)患者的死亡风险显著降低。结论：基于这一管理数据，急性心肌梗死患者的医院直接经皮冠状动脉介入治疗量与住院死亡率呈负相关。定期结果研究是必要的，与经皮冠状动脉介入治疗实践和技术的进步相结合，以确定建议的经皮冠状动脉介入治疗容量和区域化，以改善护理。(保监会J 2011；75：1107-1112)
Background: Primary percutaneous coronary intervention (PCI) is an important treatment option for patients with acute myocardial infarction (MI). Although an inverse association between a hospital's PCI volume and in-hospital mortality has been observed in Western studies, previous Japanese investigations have not found any such relationship.Methods and Results: A retrospective analysis of 8,391 cases of acute MI, obtained from administrative data from 2006. The primary outcome was in-hospital mortality. Hospitals were divided into quartiles based on the number of PCI procedures per half-year (6-13, 14-22, 23-38, 39-134) and mortality rates were compared across the groups. Crude-mortality in the lowest-volume quartile was 7.0%, compared with 4.9% in the highest-volume quartile. An inverse association was found between primary PCI procedure volume and crude in-hospital mortality (P=0.016). After case-mix adjustment, a significant decrease in mortality risk for patients treated at high-volume (3(rd) and 4(th) quartile) hospitals compared to the lowest-volume (1(st) quartile) hospitals was found.Conclusions: Based on this administrative data, there is an inverse association between a hospital's primary PCI volume and in-hospital mortality for patients with acute MI. Periodic outcomes research is necessary in conjunction with progress in PCI practice and technology to establish the recommended PCI volume and regionalization for improvements in care. (Circ J 2011; 75: 1107-1112)