2009~2018年北京地区经皮冠状动脉介入治疗后患者住院死亡率变化趋势和死亡影响因素的分析

目的:分析北京地区2009~2018年经皮冠状动脉介入治疗(PCI)后住院死亡率的变化趋势,并评估影响PCI后住院死亡率的医院相关因素。方法:本研究采用2009年1月至2018年12月北京心血管介入质量控制与改进中心的数据库,将纳入研究的56家医院根据最新的中国医疗等级评定分为三甲医院和非三甲医院,分别比较2009~2018年总体PCI后住院死亡率,急诊PCI后住院死亡率和择期PCI后住院死亡率的变化趋势。使用Logistic模型分析PCI后患者住院期间死亡的医院相关因素。结果:10年间北京地区整体PCI后住院死亡率未见明显改变,其中三甲医院的择期PCI后住院死亡率呈明显降低趋势(P<0.01)。多因素分析发现,护士人数(OR=0.923,95%CI:0.886~0.956,P=0.034)、冠心病专用导管室间数(OR=0.947,95%CI:0.863~0.992,P=0.021)和心内科排名(OR=0.552,95%CI:0.397~0.874,P=0.047)与整体PCI后住院死亡风险降低相关,进一步分析发现,冠心病专用导管室间数(OR=0.845,95%CI:0.767~0.916,P=0.012)与三甲医院PCI后住院死亡风险降低相关,而具备高级职称介入医师人数(OR=0.082,95%CI:0.031~0.523,P=0.032)和主动脉内球囊反搏(IABP)数目(OR=0.471,95%CI:0.034~0.891,P=0.021)与非三甲医院住院死亡风险降低相关。结论:2009~2018年间,北京地区整体PCI后住院死亡率未见明显改变,但三甲医院的择期PCI后住院死亡率呈明显降低趋势。非三甲医院应当增加高级职称医师的培训和IABP的配备。

Trends and Independent Risk Factors of In-hospital Death Among Patients Undergoing Percutaneous Coronary Intervention in Beijing From 2009 to 2018

Objectives:To analyze and compare the trends in the in-hospital mortality rate of patients who underwent percutaneous coronary intervention(PCI)therapy between the top-ranked hospitals in Beijing and non-ranked hospitals from 2009 to 2018,and to evaluate the independent risk factors related to in-hospital mortality in these patients during this period.Methods:The 56 hospitals participating the registry of the Beijing Interventional Quality Control Center were divided into the top-ranked and non-ranked hospitals.The trends of overall in-hospital mortality,primary PCI in-hospital mortality and selective PCI in-hospital mortality during 2009-2018 were compared between the two groups.Multivariate logistic analysis was used to determine the hospital-related independent factors for in-hospital death after PCI.Results:In the past 10 years,there was no significant change in the overall PCI in-hospital mortality rate in Beijing,but the mortality rate of selective PCI in the top-ranked hospitals showed a downward trend(P<0.01).Multivariate logistic analysis showed that the number of nurses(OR=0.923,95%CI:0.886-0.956,P=0.034),catheterization rooms(OR=0.947,95%CI:0.863-0.992,P=0.021)and hospital rankings(OR=0.552,95%CI:0.397-0.874,P=0.047)were associated with a decreased risk of in-hospital death among all patients.Subgroup analysis showed that the number of catheterization rooms(OR=0.845,95%CI:0.767-0.916,P=0.012)was associated with a decreased risk of in-hospital death in patients admitted to the top-ranked hospitals.The number of senior PCI physicians(OR=0.082,95%CI:0.031-0.523,P=0.032)and intra-aortic balloon pumping(IABP)(OR=0.471,95%CI:0.034-0.891,P=0.021)were associated with a decreased risk of in-hospital death in non-ranked hospitals.Conclusions:There is no significant change in the overall intervention-related in-hospital mortality in Beijing during 2009-2018,but the mortality of selective PCI in the top-ranked hospitals shows a downward trend.Non-ranked hospitals should enhance the education of senior PCI physicians and equipment with more IABP for the purpose of keeping the lower in-hospital death post PCI.