不同地域急性心肌梗死患者接受经皮冠状动脉介入诊疗差异

Regional disparity of Chinese patients with acute myocardial infarction treated with percutaneous coronary intervention

目的探讨我国南、北方医院接受急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)的诊疗差异。方法选取自2010年1月至2015年5月入选"全军心血管介入诊疗管理系统"数据库且行PCI的48 682例AMI患者为研究对象。按照地域划分为南方、北方医院,比较两组患者直接PCI比例、手术入路、术前直径狭窄程度以及冠状动脉病变类别等差异。结果北方AMI患者直接PCI比例明显低于南方患者(P<0.05);北方医院患者经股动脉入路比例显著低于南方医院,经桡动脉、经肱动脉入路比例显著高于南方医院(P<0.05);北方医院AMI患者靶血管术前完全闭塞比例高于南方医院,重度狭窄比例低于南方医院(P<0.05);北方AMI患者的长病变及钙化病变比例高于南方患者,血栓病变及分叉病变比例低于南方患者(P<0.05)。结论南、北方医院接受PCI治疗的AMI患者具有不同的发病特点及诊疗模式,本研究结果可作为不同地域医院AMI患者介入质控的依据及参考。

Objective To investigate the diagnosis and treatment of percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI)in southern and northern hospital.Methods A retrospective study was performed on 48 682 cases of AMI patients who were enrolled in the database of the'military cardiovascular interventional treatment and management system'and underwent PCI from January 2010 to May 2015.The patients were divided into the southern and northern hospitals according to regions,and the differences of direct PCI ratio,surgical approach,preoperative diameter stenosis degree and coronary artery disease type between the two groups were compared.Results The ratio of primary PCI of northern AMI patients was much lower than that of south patients(P<0.05).The ratio of femoral artery approach in northern hospital was significantly lower than that in southern hospital,and the ratio of radial artery and brachial artery approach was significantly higher than that in southern hospital(P<0.05).The ratio of complete occlusion and severe stenosis in AMI patients in northern hospital was higher than that in southern hospital(P<0.05).The proportion of long lesions and calcification in AMI patients in the north was higher than that in patients in the south,and the proportion of thrombosis and bifurcation lesions was lower than that in patients in the south(P<0.05).Conclusion AMI patients receiving PCI in hospitals in the north and south have different characteristics and diagnosis and treatment modes.The results of this study can be used as the basis and reference for intervention quality control of AMI patients in hospitals in different regions.