上海和伦敦冠状动脉造影指证的差异对比

Assessing coronary angiography appropriateness——the comparison of clinic and angiograms data between Shanghai and London

目的:观察并分析上海与伦敦入院行冠状动脉造影的患者在冠状动脉造影指征、相关无创性检查及造影结果方面的差异。方法:回顾性分析同时期上海416例与伦敦3524例连续性冠状动脉造影患者病史,重点分析冠状动脉造影指征、相关无创性检查及冠状动脉造影结果。结果:上海70岁以上老年人冠状动脉造影的比例明显低于伦敦患者(7%∶20%P<0.01);因慢性稳定型心绞痛冠状动脉造影的比例上海明显低于伦敦(22%∶39%,P<0.01),而50岁以下患者、因急性心肌梗死冠状动脉造影的比例上海高于伦敦(分别为28%∶15%,P<0.01,和10%∶6%,P<0.01),因不典型胸痛和无心绞痛症状的而行冠状动脉造影的比例上海也远高于伦敦(均P<0.01)。由于其他原因而行冠状动脉造影的比例上海也高于伦敦(25%∶15%,P<0.01)。冠状动脉造影结果显示伦敦患者2、3支病变比例远高于上海(21.3%∶14.9%,23.6%∶11.8%P<0.01),而正常和轻、中度病变的比例明显低于上海(均P<0.01)。以冠状动脉狭窄>50%为冠心病的诊断标准,上海冠状动脉造影阳性率为44.6%,明显低于伦敦的72.2%(P<0.01)。上海冠状动脉造影前进行活动平板检查的比例明显低于伦敦(12%∶47%,P<0.01),但Holter和普通心脏B超的检查比例却明显高于伦敦(分别为63%∶3%和83%∶17%,均P<0.01)。结论:上海行冠状动脉造影的指征较松,冠状动脉造影阳性率较低,对冠心病初筛的相关无创性检查应用不合理。

Objective：To compare the characteristics of clinic and angiograms in patients between Shanghai and London, and assess coronary angiography appropriateness in Shanghai and London. Method： Retrospectives analysis was performed to compare the clinical characteristics of patients in Shanghai and London including age, clinical diagnosis, special tests for coronary artery disease before angiography, and angiographic results. Result： Undertaken coronary angiogram the proportion of patients aged below 50 was higher in Shanghai than in London. But patients aged above 70 were less in Shanghai （28% vs 15%, 7% vs 20% P〈0. 001 respectively）. The proportion of chronic stable angina pectoris was lower but that of AMI were higher in Shnaghai than in London （22 % ：39%, P〈0. 01; 10% ;6%, P〈0. 01 respectively）. The proportion of patients with atypical chest pain and without symptom undertaken coronary angiogram was higher in Shanghai than in London （14%： 5%, 10%：4%,P〈0. 01）. And the proportion of patients with miscellaneous causes was higher in Shanghai（25% ：15%, P〈0. 01）. Exercise electrocardiograms were performed less widely in Shanghai than in London （12% ：47%, P〈0. 01）. While Holter and transthoracic echocardiograms were used much more in Shanghai than in London （63 % ：3%, 83% ：17%,P〈0. 01）. Angiograms revealed a low proportion of two or three vessel diseases in Shanghai compared to London, （14.9%：21.3%, 11.8%：23.6% ,P〈0.01）, and a high proportion of normal vessels, mild and moderate vessel diseases in Shanghai（18.2% ：37.0%, 9.6% ： 16.4%, P〈0.01）. The rate of positive coronary angiogram was significantly lower in Shanghai than in London if stenosis of coronary artery was more than 50% considered as positive outpoint（44.6 % ： 72.2 %, P〈0. 01）. Conclusion： Compared to London, the coronary angiography appropriateness was performed not strictly in Shanghai. Medical resources were not used appropriately in Shanghai.