Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan.
Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan.
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DOI：
10.1016/j.lanwpc.2022.100425
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发表时间：
2022-05
期刊：
影响因子：
--
通讯作者：
Kohsaka S
中科院分区：
文献类型：
--
作者：
Shoji S;Yamaji K;Sandhu AT;Ikemura N;Shiraishi Y;Inohara T;Heidenreich PA;Amano T;Ikari Y;Kohsaka S
测量护理质量对于改善接受经皮冠状动脉介入治疗（PCI）的患者的结局至关重要。本研究描述了使用代表性日本国家登记系统进行PCI的质量指标的性能率和区域差异。总体而言，分析了714家机构（2016-2018年）的760，854例患者。质量指标包括术前抗血小板治疗的使用、ST段抬高心肌梗死患者入院至球囊扩张时间≤90 min、经桡动脉入路和日本47个县择期病例的术前无创负荷试验。还评价了冠状动脉计算机断层扫描血管造影（CCTA）和血流储备分数（FFR）。与术前检查率相关的因素采用多变量线性回归进行评价。术前抗血小板治疗的使用率较高，变异性较低（96.4%[94.7 - 97.2%]），但门到球囊时间（74.7%[71.2 - 78.9%]）和经桡动脉入路使用率（70.9%[65.1 - 73.4%]）仍有很大的改善空间。术前无创应力测试的发生率较低，差异较大（36.6%[27.1 - 49.7%]）。此外，我们发现CCTA（50.0%[39.5 - 55.1%]）和FFR测量（15.7%[113. -18.3%]）率存在显著差异。每个县的骨密度扫描仪的数量与无创压力测试的性能相关（每增加1/100，000人口的扫描仪，增加13.4%[95%CI，2.45 - 24.4%]）。我们观察到，在使用程序前测试，其性能是直接相关的核扫描仪的可用性显着的区域差异。这些调查结果表明，需要有针对性地努力提高检测率，无论是通过优化资源分配还是通过额外的教育或反馈机制。本研究由日本科学促进会资助（批准号：20 H 03915、16 H 05215、16 KK 0186和20 K22883）和厚生劳动省科学研究资助计划（资助号21 FA 1015）J-PCI注册由日本心血管介入和治疗协会领导和支持。
Measuring the quality of care has been central for improving the outcomes of patients undergoing percutaneous coronary intervention (PCI). This study described the performance rates and regional variations in quality metrics for PCI using a representative national Japanese registry. Overall, 760,854 patients across 714 institutions (2016–2018) were analysed. Quality metrics included preprocedural antiplatelet therapy use, door-to-balloon time ≤90 min for ST-elevation myocardial infarction, transradial approach, and preprocedural noninvasive stress testing for elective cases in 47 Japanese prefectures. Coronary computed tomography angiography (CCTA) and fractional flow reserve (FFR) were also evaluated. Factors associated with preprocedural testing rates were evaluated using multivariable linear regression. Rates of preprocedural antiplatelet therapy use were high with low variations (96·4% [94·7–97·2%]), but there was still substantial room for improvement in the rates of door-to-balloon time (74·7% [71·2–78·9%]) and transradial approach use (70·9% [65·1–73·4%]). Rates of preprocedural noninvasive stress testing were low with substantial variation (36·6% [27·1–49·7%]). Additionally, we found substantial variations in CCTA (50·0% [39·5–55·1%]) and FFR measurement (15·7% [113·–18·3%]) rates. The number of scintigraphy scanners/ prefecture was associated with the performance of noninvasive stress testing (13·4% [95% CI, 2·45–24·4%] increase for every 1/100,000 population increase in scanners). We observed substantial regional variation in the use of preprocedural testing, and its performance was directly related to nuclear-scanner availability. These findings suggest the need for targeted efforts in improving testing rates, whether by optimising resource allocation or additional education or feedback mechanisms. This study was funded by the Japan Society for the Promotion of Science (Grant Nos. 20H03915, 16H05215, 16KK0186, and 20K22883) and by the Ministry of Health, Labor and Welfare Grants-in-Aid for Scientific Research Program (Grant No. 21FA1015). The J-PCI registry is led and supported by the Japanese Association of Cardiovascular Intervention and Therapeutics.
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影响因子：
168.9
作者：
Nallamothu, Brahmajee K.;Normand, Sharon-Lise T.;Wang, Yongfei;Hofer, Timothy P.;Brush, John E., Jr.;Messenger, John C.;Bradley, Elizabeth H.;Rumsfeld, John S.;Krumholz, Harlan M.
通讯作者：
Krumholz, Harlan M.
影响因子：
120.7
作者：
Chan, Paul S.;Patel, Manesh R.;Klein, Lloyd W.;Krone, Ronald J.;Dehmer, Gregory J.;Kennedy, Kevin;Nallamothu, Brahmajee K.;Weaver, W. Douglas;Masoudi, Frederick A.;Rumsfeld, John S.;Brindis, Ralph G.;Spertus, John A.
通讯作者：
Spertus, John A.
影响因子：
3.6
作者：
Alghanem, Fares;Clements, John M.
通讯作者：
Clements, John M.
影响因子：
24
作者：
Jneid, Hani;Addison, Daniel;Pancholy, Samir
通讯作者：
Pancholy, Samir
影响因子：
2.3
作者：
Levine, Glenn N.;Bates, Eric R.;Zhao, David X.
通讯作者：
Zhao, David X.