Impact of drug-eluting stents on treatment option mix for coronary artery disease in Japan.
Impact of drug-eluting stents on treatment option mix for coronary artery disease in Japan.
复制标题
药物洗脱支架对日本冠状动脉疾病治疗方案组合的影响。
作者：
H. Horiguchi;H. Yasunaga;H. Hashimoto;S. Matsuda
背景
在日本，药物洗脱支架（DES）于2004年9月引入。本研究的目的是阐明DES如何影响在日本进行的经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的比例。
方法和结果
使用日本诊断程序组合（DPC）住院患者数据库，2004年至2007年期间，每年7月从144家医院确定了19，248例心绞痛（AP）患者和2，895例急性心肌梗死（AMI）患者。在AP患者中，保守治疗的比例从2004年的70%下降到2007年的61%，而PCI手术的比例从2004年的25%上升到2007年的32%。体外循环冠状动脉搭桥术例数从2004年的3.5%下降到2007年的2.7%，但非体外循环冠状动脉搭桥术例数从2004年的2.2%持续增加到2007年的4.0%。急性胰腺炎患者的总体住院死亡率从2004年的0.35%逐渐下降到2007年的0.18%。2007年，DES用于所有AP患者的23%和所有AMI患者的26%。多因素Logistic回归分析显示，非教学医院DES的使用比例高于教学医院。
结论
在引入DES后，PCI有了显著的扩展，非体外循环CABG也逐渐增加。在日本建立心脏病专家和心血管外科医生之间关于循证最佳实践的共识指南至关重要。
BACKGROUND
In Japan, drug-eluting stents (DES) were introduced in September 2004. The aim of the present study was to clarify how DES affected the proportions of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures performed in Japan.
METHODS AND RESULTS
Using the Japanese Diagnosis Procedure Combination (DPC) inpatient database, 19,248 patients with angina pectoris (AP) and 2,895 patients with acute myocardial infarction (AMI) were identified from 144 hospitals in July of each year between 2004 and 2007. Among AP patients, the proportion of conservative therapies decreased from 70% in 2004 to 61% in 2007, while the proportion of PCI procedures increased from 25% in 2004 to 32% in 2007. On-pump CABG cases decreased from 3.5% in 2004 to 2.7% in 2007, but the number of off-pump CABG cases continuously increased from 2.2% in 2004 to 4.0% in 2007. Overall in-hospital mortality in AP patients gradually decreased from 0.35% in 2004 to 0.18% in 2007. In 2007, DES was used in 23% of all AP patients and 26% of all AMI patients. Multi-nominal logistic regression analysis showed that the proportional use of DES was greater in non-teaching hospitals than in teaching hospitals.
CONCLUSIONS
There has been marked expansion of PCI and a gradual increase in off-pump CABG after the introduction of DES. It is essential to establish guidelines in Japan for a consensus between cardiologists and cardiovascular surgeons on evidence-based best practice.
影响因子：
158.5
作者：
Marroquin, Oscar C.;Selzer, Faith;Kip, Kevin E.
通讯作者：
Kip, Kevin E.
DOI：
10.1056/nejm199607253350401
发表时间：
1996-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
M. Bourassa;R. Frye;S. King;K. Detre;E. Alderman;K. Andrews;G. Sopko
通讯作者：
M. Bourassa;R. Frye;S. King;K. Detre;E. Alderman;K. Andrews;G. Sopko