Chinese Medical Sciences Journal ›› 2017, Vol. 32 ›› Issue (3): 161-170.doi: 10.24920/J1001-9294.2017.023

• 论著 • 上一篇    下一篇

中国老年患者经桡动脉与股动脉介入治疗比较

金辰, 徐奕, 乔树宾, 唐欣然, 吴永健, 颜红兵, 窦克非, 徐波, 杨进刚, 杨跃进*()   

  1. 国家心血管病中心,中国医学科学院 北京协和医学院 阜外医院,北京 100037
  • 收稿日期:2016-12-07 出版日期:2017-09-27 发布日期:2017-09-27
  • 通讯作者: 金辰,徐奕,杨跃进 E-mail:yangyjfw@126.com

Transradial Versus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China: A Retrospective Analysis

Jin Chen?, Xu Yi?, Qiao Shu-bin, Tang Xin-ran, Wu Yong-jian, Yan Hong-bing, Dou Ke-fei, Xu Bo, Yang Jin-gang, Yang Yue-jin*()   

  1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
  • Received:2016-12-07 Published:2017-09-27 Online:2017-09-27
  • Contact: Jin Chen,Xu Yi,Yang Yue-jin E-mail:yangyjfw@126.com

摘要:

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。

关键词: 老年, 股动脉路径, 桡动脉路径, 经皮冠状动脉介入治疗, 费用

Abstract: Objective

To compare hospital costs and clinical outcomes between transradial intervention (TRI) and transfemoral intervention (TFI) in elderly patients aged over 65 years.

Methods

We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention (PCI) in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting (IPW) model was introduced to control potential biases.

Results

Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 (95%CI: CNY4419-10 420). Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay (1.9 days, 95%CI: 1.1-2.7 days), shorter post-procedural stay (0.7 days, 95%CI: 0.3-1.1 days), and fewer major adverse cardiac events (adjusted odds ratio = 0.47, 95%CI: 0.31-0.73). There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI (P>0.05). Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina.

Conclusion

The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.

Key words: coronary artery disease, cost-benefit analysis, percutaneous coronary intervention, aged, transradial intervention, transfemoral intervention

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