论文部分内容阅读
目的从院内费用和临床结果两方面对65岁以上老年患者经桡动脉与股动脉路径行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)进行比较和评价,为老年患者介入路径选择提供临床和卫生经济学依据。方法本研究为回顾性研究,共纳入阜外医院2010年1月1日至2010年12月31日收治的1229例年龄>65岁的PCI病例。其中,经桡动脉路径介入治疗(transradial intervention,TRI)1033例,经股动脉路径介入治疗(transfemoral intervention,TFI)196例。研究使用倾向性评分的逆概率加权法(inverse probability weighting,IPW)对两种路径的患者院内费用和临床结局进行了比较。依据出血学术研究联合会标准,对出血并发症及主要不良心血管事件(包括院内全因死亡、心肌梗死、住院期间再次血运重建及BARC分级≥3)进行了比较。结果与TFI组相比,TRI组患者平均年龄较低,女性患者所占比例较低,且既往心肌梗死、既往冠状动脉旁路移植术史、既往PCI及既往卒中病史均较少。造影结果提示TRI组患者单支病变比例较高,而开口病变比例则较低。IPW调整后,TRI组患者的院内费用明显低于TFI组,差值为CNY7495(95%CI:4419-10420,P<0.0001),造成住院费用差异的主要原因是TRI组患者PCI术中花费较低。IPW调整后TRI组患者住院时间较短(差值=1.9 d,95%CI:1.1-2.7,P<0.0001),且主要不良心血管事件较少(OR=0.47,95%CI:0.31-0.73,P<0.001)。IPW调整前后,两组患者出血并发症的差异在无统计学意义(P>0.05)。结论与股动脉路径PCI相比,桡动脉路径可降低65岁以上老年患者院内费用,缩短住院时间,减少主要不良心血管事件的发生。
Objective To compare and evaluate percutaneous coronary intervention (PCI) between radial artery and femoral artery in elderly patients over 65 years of age from both inpatient cost and clinical outcome, so as to provide clinical and hygienic Economic basis. Methods This study was retrospectively studied and included 1229 PCI patients aged> 65 years who were admitted to Fuwai Hospital from January 1, 2010 to December 31, 2010. Among them, there were 1033 cases of transradial intervention (TRI) and 196 cases of transfemoral intervention (TFI) through the femoral artery. The study used inverse probability weighting (IPW) using propensity scores to compare in-hospital costs and clinical outcomes for both pathways. Hemorrhagic complications and major adverse cardiovascular events (including all-cause hospital death, myocardial infarction, revascularization during hospitalization, and BARC grade ≥3) were compared according to the Society for Hemorrhage Academic Standards. Results Compared with the TFI group, the average age of patients in the TRI group was lower than that in the TFI group, and the proportion of female patients was lower. Previous myocardial infarction, previous coronary artery bypass grafting, previous PCI and previous stroke history were less. Angiography results suggest that patients with TRI group a higher proportion of single-vessel disease, while the proportion of open lesions is lower. After adjustment for IPW, hospital expenses in patients in the TRI group were significantly lower than those in the TFI group, with a difference of CNY7495 (95% CI: 4419-10420, P <0.0001). The main reason for differences in hospitalization costs was the cost of PCI in the TRI group low. Patients in the TRI group had shorter length of stay (difference = 1.9 d, 95% CI: 1.1-2.7, P <0.0001) and fewer major adverse cardiovascular events after adjustment for IPW (OR = 0.47, 95% CI: 0.31-0.73 , P <0.001). Before and after IPW adjustment, there was no significant difference in the bleeding complications between the two groups (P> 0.05). Conclusion Compared with the femoral artery PCI, the radial artery pathway can reduce the cost of hospitalization for elderly patients over the age of 65, shorten the hospital stay and reduce the incidence of major adverse cardiovascular events.