Twenty-five-year trends in in-hospital and long-term outcome after percutaneous coronary intervention - A single-institution experience

Article

关键词: ARTERY-BYPASS-SURGERY;    ACUTE MYOCARDIAL-INFARCTION;    CURRENT ERA;    ANGIOPLASTY;    REGISTRY;    REVASCULARIZATION;    COMPLICATIONS;   

DOI  :  10.1161/CIRCULATIONAHA.106.632679

来源: SCIE

【 摘 要 】

Background-Little is known about the impact of technological and pharmacological advances on long-term outcome after percutaneous coronary intervention in general clinical practice. Methods and Results-We analyzed in-hospital and long-term outcome of 24410 percutaneous coronary interventions among 18 575 unique patients who underwent percutaneous coronary intervention at Mayo Clinic over 25 years. The study population was divided into group 1 (n = 3708), coronary interventions from 1979 to 1989; group 2 (n=7020), interventions from 1990 to 1996; group 3 (n = 10 952), interventions from 1996 to 2003; and group 4 (n = 2730), interventions from 2003 to 2004. Despite the fact that patients in groups 3 and 4 were significantly older, sicker, and had greater prevalence of comorbid conditions, heart failure, and previous revascularization than those in groups 1 and 2, procedural success in groups 3 and 4 improved significantly ( 94%) versus groups 2 ( 89%) and 1 ( 78%) ( P < 0.001). Significant reduction in in- hospital mortality ( groups 4 to 1: 1.8%, 1.7%, 2.6%, 3.0%; P < 0.001) and need for emergency bypass surgery ( groups 4 to 1: 0.4%, 0.5%, 1.6%, 5%; P = 0.001) was noted in groups 3 and 4 compared with groups 1 and 2. Better adherence to currently recommended evidence- based medications for secondary prevention was seen in the recent time periods. After adjustment, significant reduction in follow- up mortality (hazard ratio, 0.81 and 0.74 for groups 3 and 4, respectively); death or myocardial infarction ( hazard ratio, 0.80 and 0.75 for groups 3 and 4, respectively); death, myocardial infarction, or revascularization (hazard ratio, 0.76 and 0.58 for groups 3 and 4, respectively) was noted in recent time periods. Conclusions-Despite higher-risk profiles of patients who underwent percutaneous coronary intervention in recent time periods, procedural success as well as in- hospital and long- term outcomes improved significantly over the last 25 years.

【 授权许可】

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