Rate of Percutaneous Coronary Intervention for the Management of Acute Coronary Syndromes and Stable Coronary Artery Disease in the United States (2007 to 2011)
Rate of Percutaneous Coronary Intervention for the Management of Acute Coronary Syndromes and Stable Coronary Artery Disease in the United States (2007 to 2011)
复制标题
DOI：
10.1016/j.amjcard.2014.07.013
复制
发表时间：
2014-10-01
影响因子：
2.8
通讯作者：
Wong, S. Chiu
中科院分区：
文献类型：
--
作者：
Kim, Luke K.;Feldman, Dmitriy N.;Wong, S. Chiu
尽管经皮冠状动脉介入治疗（PCI）对急性冠状动脉综合征（ACS）患者的益处已在许多研究中得到证实，但PCI在稳定性冠状动脉疾病（CAD）中的作用仍存在争议。随着利用血运重建和积极药物评价试验的临床结局和冠状动脉血运重建的适当使用标准的发表，我们试图检查这些治疗策略和指南对美国目前PCI实践的影响。我们对2007年至2011年接受PCI治疗ACS和稳定型CAD的患者进行了一项系列横断面研究，研究时间趋势。所有PCI的年发生率从2007年至2008年的每百万成人每年10，785例手术下降到2010年至2011年的每百万成人每年7，801例手术，下降了27.7%（p = 0.03）。尽管2007年至2011年ACS的PCI使用率没有统计学显著性下降，但稳定性CAD的PCI使用率下降了51.7%（从2008年的每年每百万成人2，056例手术降至2011年的每年每百万成人992例手术，p = 0.02）。PCI量较高的医院出现了更显著的下降。对于有医疗保险和私人保险/健康维护组织的患者，稳定型CAD的PCI使用率下降具有统计学意义（分别为44.5%，p = 0.03和59.5%，p = 0.007）。总之，从2009年开始，美国的PCI率大幅下降。大部分减少归因于稳定型CAD的PCI使用减少。(C)2014年爱思唯尔公司All rights reserved.
Although the benefit of percutaneous coronary interventions (PCIs) for patients presenting with acute coronary syndromes (ACS) has been established in numerous studies, the role of PCI in stable coronary artery disease (CAD) remains controversial. With the publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluations trial and the appropriate use criteria for coronary artery revascularization, we sought to examine the impact of these treatment strategies and guidelines on the current practice of PCI in United States. We conducted a serial cross-sectional study with time trends of patients undergoing PCI for ACS and stable CAD from 2007 to 2011. The annual rate of all PCI decreased by 27.7% from 10,785 procedures per million adults per year in 2007 to 2008 to 7,801 procedures per million adults per year in 2010 to 2011 (p = 0.03). Although there was no statistically significant decrease in the PCI utilization for ACS from 2007 to 2011, PCI utilization for stable CAD decreased by 51.7% (from 2,056 procedures per million adults per year in 2008 to 992 procedures per million adults per year in 2011, p = 0.02). Hospitals with a higher volume of PCI experienced a more significant decrease. Decrease in PCI utilization for stable CAD was statistically significant for patients with Medicare and private insurance/health maintenance organization (44.5%, p = 0.03 and 59.5%, p = 0.007, respectively). In conclusion, the rate of PCI decreased substantially starting from 2009 in the United States. Most of the decrease was attributed to the reduction in PCI utilization for stable CAD. (C) 2014 Elsevier Inc. All rights reserved.