直接和补救经皮冠状动脉腔内成形术的疗效和费用效果比

Primary PCI and rescue PCI:Comparison of outcome and cost/effectiveness

目的 比较直接经皮冠状动脉腔内成形术 (直接PCI)和补救PCI治疗急性心肌梗死 (AMI)的疗效和费用效果比。 方法 采用观察性对列研究的方法。连续选取 2 0 0 0年 1月 1日 2 0 0 1年 12月 31日天津医科大学第二医院心脏科直接PCI治疗的AMI患者 5 9例以及补救PCI治疗的患者 2 9例。比较两组患者住院期及随访期的临床疗效、费用及费用效果比。 结果 两组患者基线资料完全匹配。冠脉造影显示血管的情况无差别。虽然从入院到血管再通时间补救PCI组长于直接PCI组 (2 19 4 7min± 10 3 5 9min比 116 0 5min± 5 4 4 6min) (P =0 0 0 0 ) ,但PCI术成功率两组间无统计学差别。住院期间心衰、心绞痛、再发心梗、出血等的发生率 ,病死率 ,监护日及住院日均无统计学差异。随访期累计心衰的发生率直接PCI组为 13 6 0 % ,补救PCI组为 31 0 0 % (P =0 0 5 0 ) ;再发心梗、再入院、再次冠脉介入或搭桥手术的发生率及总病死率两组无统计学差异。住院费用和总费用 ,补救PCI组高于直接PCI组 ;心功能获益的费用效果比 ,直接PCI组优于补救PCI组。 结论 补救PCI与直接PCI相比 ,手术同样安全有效。但是 ,慢性期心衰的发生率补救PCI高于直接PCI,费用也高于直接PCI。费用效果比 ,直接PCI优于补救PCI。

Objective To compare the outcome and cost/effectiveness of primary PCI and rescue PCI for acute myocardial infarction. Methods This is an observing cohort study.Between January 1 of 2000 and December 31 of 2001,we selected consecutively 59 patients who were treated with primary PCI and 29 patients treated with rescue PCI,all of them suffered from AMI.The clinical outcome and costs of the two groups were compared in hospitalization and follow up period. Results Baseline and angiographic parameters were not significantly different in the two groups.Although from admission to vascular recanalization the rescue PCI group was longer than that of primary PCI group(219.47min±103.59min and 116.05min±54.46min)(P=0.000),the procedural success rate of the two groups was similar.In hospitalization there were no siginficant difference between the two groups on the incidence of heart failure,recurrent angina,pectoris and myocardial infarction,bleeding complications etc.,days of monitor and hospitalization case-fatality rate,in follow-up survey(14.62±6.77 months) only the cumulative incidence of heart failure was 13.60% in primary PCI versus 31.00% in rescue PCI(P=0.050) and the others were not significantly different.The hospitalization expenditure,total cost in rescue PCI group were costly,so the outcome in PCI group was a benefit to the patients. Conclusion The operative result was similar in the two groups,but in primary PCI group the outcome and cost/effectiveness would be better than rescue PCI group.