■在过去的四十年中,经皮冠状动脉介入治疗(PCI)的经验与技术进步相结合,导致PCI利用率和复杂性逐渐增加。我们旨在调查PCI复杂性的时间趋势和我们机构中复杂PCI(C-PCI)的结果。
我们分析了在12年期间执行的20,301例连续PCI手术。C-PCI定义为涉及以下至少一种的手术:慢性完全闭塞(CTO),左主(LM),分叉或隐静脉移植(SVG)PCI。定义了四个3年时间间隔的时期(2008-10年、2011-2013年、2014-2016年、2017-2019年),研究了这些间隔内C-PCI发生率和结局的时间趋势.终点包括死亡率和主要不良心脏事件[MACE:死亡,急性心肌梗死(MI),和目标血管血运重建(TVR)]在1年。
■共进行了5,647例(27.8%)C-PCI手术。自2017年以来,C-PCI的发生率显着上升(31.2%,p<0.01),主要由分叉和LM干预驱动(p<0.01)。在1年,死亡率,急性MI,TVR和MACE,在C-PCI组中均显着较高(8.8vs.5.1%,5.6vs.4.5%,5.5vs.4.0%,17.2vs.12.2%,所有p<0.001,分别),与非复杂组相比。在研究后期(2014-2019年)进行的C-PCI与改善的1年TVR相关(4.4%和4.8%vs.6.7%和7.1%,分别为p=0.01)和MACE(13.8%和13.5%vs.17.3%和18.2%,分别为p=0.001)与前一时期(2007-2013年)相比的比率。死亡率没有随时间显著下降。
■在当前队列中,我们发现PCI复杂性随时间增加,C-PCI1年临床结局改善.
UNASSIGNED: Accumulated experience combined with technological advancements in percutaneous coronary interventions (PCI) over the past four decades, has led to a gradual increase in PCI utilization and complexity. We aimed to investigate the temporal trends in PCI complexity and the outcomes of complex PCI (C-PCI) in our institution.
UNASSIGNED: We analyzed 20,301 consecutive PCI procedures performed over a 12-year period. C-PCI was defined as a procedure involving at least one of the following: Chronic total occlusion (CTO), left main (LM), bifurcation or saphenous vein graft (SVG) PCI. Four periods of 3-year time intervals were defined (2008-10, 2011-2013, 2014-2016, 2017-2019), and temporal trends in the rate and outcomes of C-PCI within these intervals were studied. Endpoints included mortality and major adverse cardiac events [MACE: death, acute myocardial infarction (MI), and target vessel revascularization (TVR)] at 1 year.
UNASSIGNED: A total of 5,647 (27.8%) C-PCI procedures were performed. The rate of C-PCI has risen significantly since 2,017 (31.2%, p < 0.01), driven mainly by bifurcation and LM interventions (p < 0.01). At 1-year, rates of death, acute MI, TVR and MACE, were all significantly higher in the C-PCI group (8.8 vs. 5.1%, 5.6 vs. 4.5%, 5.5 vs. 4.0%, 17.2 vs. 12.2%, p < 0.001 for all, respectively), as compared to the non-complex group. C-PCI preformed in the latter half of the study period (2014-2019) were associated with improved 1-year TVR (4.4% and 4.8% vs. 6.7% and 7.1%, p = 0.01, respectively) and MACE (13.8% and 13.5% vs. 17.3% and 18.2%, p = 0.001, respectively) rates compared to the earlier period (2007-2013). Death rate had not significantly declined with time.
UNASSIGNED: In the current cohort, we have detected a temporal increase in PCI complexity coupled with improved 1-year clinical outcomes in C-PCI.