In-Hospital Coronary Revascularization Rates and Post-Discharge Mortality Risk in Non-ST-Segment Elevation Acute Coronary Syndrome
In-Hospital Coronary Revascularization Rates and Post-Discharge Mortality Risk in Non-ST-Segment Elevation Acute Coronary Syndrome
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DOI：
10.1016/j.jacc.2019.06.068
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发表时间：
2019-09-17
影响因子：
24
通讯作者：
Huo, Yong
中科院分区：
文献类型：
--
作者：
Bueno, Hector;Rossello, Xavier;Huo, Yong
非ST段抬高急性冠脉综合征存活者的院内冠状动脉血运重建率（CRR）与出院后死亡率之间的关系本研究的目的是评估NSTE-ACS患者的CRR和2年出院后死亡率（2 YMR）。按国家和世界地区列出的11，931例存活至出院并入组EPICOR的NSTE-ACS患者（以十分位数计）（长期随访急性冠脉综合征患者的抗血栓治疗模式）和EPICOR Asia：双胞胎多国，观察性，前瞻性队列研究。结果患者基线特征，药物治疗，第一和第十个十分位数的平均CRR范围分别为0.0%至96.8%（p < 0.001）;罗马尼亚为12.3%，斯洛文尼亚为92.4%（p < 0.001）;东南亚（SEAsia）为53.9%，韩国-新加坡-香港为90.4%。2 YMR在CRR的医院十分位数（第10十分位数为3.6%，第1十分位数为9.2%; p < 0.001）、国家（斯洛文尼亚最低1.5%，马来西亚最高19.4%; p < 0.001）和地区（韩国-新加坡-香港最低3.8%，东南亚最高11.7%; p < 0.001）之间存在显著差异。Poisson回归模型，调整了15个死亡率预测因子，显示了医院CRR和2 YMR之间的显著负相关性（r = -0.90; p < 0.001），国家（r = -0.65; p < 0.001），以及区域（r = -0.87; p = 0.005）。结论：在医院、国家和世界地区水平上，较高的CRR与较高的出院后生存率密切相关，这表明CRR是较高系统质量的标志。(C)2019年由美国心脏病学会基金会。
BACKGROUND The relationship between in-hospital coronary revascularization rate (CRR) and post-discharge mortality rates in survivors of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) at a system level is unclear.OBJECTIVES The purpose of this study was to evaluate CRR and 2-year post-discharge mortality rate (2YMR) in NSTE-ACS.METHODS CRR and 2YMR were analyzed by hospital rate of CRR (in deciles), by country, and by world region in 11,931 patients with NSTE-ACS who survived to discharge and were enrolled in the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) and EPICOR Asia: twin multinational, observational, prospective cohort studies.RESULTS Significant differences in patient baseline characteristics, medical therapies, CRR, and 2YMR were found. Mean CRR ranged from 0.0% to 96.8% in the first and tenth decile, respectively (p < 0.001); from 12.3% in Romania to 92.4% in Slovenia (p < 0.001); and from 53.9% in South East Asia (SEAsia) to 90.4% in South Korea-Singapore-Hong Kong. 2YMR varied significantly between hospital deciles of CRR (3.6% in tenth decile vs. 9.2% in first decile; p < 0.001), countries (lowest 1.5% in Slovenia, highest 19.4% in Malaysia; p < 0.001), and regions (lowest 3.8% in South Korea-Singapore-Hong Kong, highest 11.7% in SEAsia; p < 0.001). Poisson regression models, adjusted for 15 mortality predictors, showed a significant inverse association between CRR and 2YMR for hospitals (r = -0.90; p < 0.001), countries (r = -0.65; p < 0.001), and regions (r = -0.87; p = 0.005).CONCLUSIONS Higher CRRs at the hospital, country, and world region levels are strongly associated with higher post-discharge survival, suggesting CRR as a marker of higher system quality. (C) 2019 by the American College of Cardiology Foundation.