慢性全闭塞经皮冠状动脉介入治疗前的当代管理:退伍军人事务临床评估、报告和跟踪计划的启示》。

IF 6.9 2区 医学 Circulation. Cardiovascular Quality and Outcomes Pub Date : 2023-03-01 Epub Date: 2023-02-01 DOI:10.1161/CIRCOUTCOMES.122.008949
Stanley A Swat, Annika Hebbe, Mary E Plomondon, Ki E Park, Rory S Bricker, Stephen W Waldo, Javier A Valle
{"title":"慢性全闭塞经皮冠状动脉介入治疗前的当代管理:退伍军人事务临床评估、报告和跟踪计划的启示》。","authors":"Stanley A Swat, Annika Hebbe, Mary E Plomondon, Ki E Park, Rory S Bricker, Stephen W Waldo, Javier A Valle","doi":"10.1161/CIRCOUTCOMES.122.008949","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend maximal antianginal medical therapy before attempted coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The degree to which this occurs in contemporary practice is unknown. We aimed to characterize the frequency and variability of preprocedural use of antianginal therapy and stress testing within 3 months before PCI of CTO (CTO PCI) across a nationally integrated health care system.</p><p><strong>Methods: </strong>We identified patients who underwent attempted CTO PCI from January 2012 to September 2018 within the Veterans Affairs Healthcare System. Patients were categorized by management before CTO PCI: presence of ≥2 antianginals, stress testing, and ≥2 antianginals and stress testing within 3 months of PCI attempt. Multivariable logistic regression and inverse propensity weighting were used for adjustment before trimming, with median odds ratios calculated for variability estimates.</p><p><strong>Results: </strong>Among 4250 patients undergoing attempted CTO PCI, 40% received ≥2 antianginal medications and 24% underwent preprocedural stress testing. The odds of antianginal therapy with more than one medication before CTO PCI did not change over the years of the study (odds ratio [OR], 1.0 [95% CI, 0.97-1.04]), whereas the odds of undergoing preprocedural stress testing decreased (OR, 0.97 [95% CI, 0.93-0.99]), and the odds of antianginal therapy with ≥2 antianginals and stress testing did not change (OR, 0.98 [95% CI, 0.93-1.04]). Median odds ratios (MOR) showed substantial variability in antianginal therapy across hospital sites (MOR, 1.3 [95% CI, 1.26-1.42]) and operators (MOR, 1.35 [95% CI, 1.26-1.63]). Similarly, preprocedural stress testing varied significantly by site (MOR, 1.68 [95% CI, 1.58-1.81]) and operator (MOR, 1.80 [95% CI, 1.56-2.38]).</p><p><strong>Conclusions: </strong>Just under half of patients received guideline-recommended management before CTO PCI, with significant site and operator variability. These findings suggest an opportunity to reduce variability in management before CTO PCI.</p>","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":"16 3","pages":"e008949"},"PeriodicalIF":6.9000,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10033351/pdf/","citationCount":"0","resultStr":"{\"title\":\"Contemporary Management Before Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.\",\"authors\":\"Stanley A Swat, Annika Hebbe, Mary E Plomondon, Ki E Park, Rory S Bricker, Stephen W Waldo, Javier A Valle\",\"doi\":\"10.1161/CIRCOUTCOMES.122.008949\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Guidelines recommend maximal antianginal medical therapy before attempted coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The degree to which this occurs in contemporary practice is unknown. We aimed to characterize the frequency and variability of preprocedural use of antianginal therapy and stress testing within 3 months before PCI of CTO (CTO PCI) across a nationally integrated health care system.</p><p><strong>Methods: </strong>We identified patients who underwent attempted CTO PCI from January 2012 to September 2018 within the Veterans Affairs Healthcare System. Patients were categorized by management before CTO PCI: presence of ≥2 antianginals, stress testing, and ≥2 antianginals and stress testing within 3 months of PCI attempt. Multivariable logistic regression and inverse propensity weighting were used for adjustment before trimming, with median odds ratios calculated for variability estimates.</p><p><strong>Results: </strong>Among 4250 patients undergoing attempted CTO PCI, 40% received ≥2 antianginal medications and 24% underwent preprocedural stress testing. The odds of antianginal therapy with more than one medication before CTO PCI did not change over the years of the study (odds ratio [OR], 1.0 [95% CI, 0.97-1.04]), whereas the odds of undergoing preprocedural stress testing decreased (OR, 0.97 [95% CI, 0.93-0.99]), and the odds of antianginal therapy with ≥2 antianginals and stress testing did not change (OR, 0.98 [95% CI, 0.93-1.04]). Median odds ratios (MOR) showed substantial variability in antianginal therapy across hospital sites (MOR, 1.3 [95% CI, 1.26-1.42]) and operators (MOR, 1.35 [95% CI, 1.26-1.63]). Similarly, preprocedural stress testing varied significantly by site (MOR, 1.68 [95% CI, 1.58-1.81]) and operator (MOR, 1.80 [95% CI, 1.56-2.38]).</p><p><strong>Conclusions: </strong>Just under half of patients received guideline-recommended management before CTO PCI, with significant site and operator variability. These findings suggest an opportunity to reduce variability in management before CTO PCI.</p>\",\"PeriodicalId\":10301,\"journal\":{\"name\":\"Circulation. Cardiovascular Quality and Outcomes\",\"volume\":\"16 3\",\"pages\":\"e008949\"},\"PeriodicalIF\":6.9000,\"publicationDate\":\"2023-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10033351/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation. Cardiovascular Quality and Outcomes\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCOUTCOMES.122.008949\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/2/1 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation. Cardiovascular Quality and Outcomes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCOUTCOMES.122.008949","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/2/1 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

背景:指南建议,在尝试冠状动脉慢性全闭塞(CTO)经皮冠状动脉介入治疗(PCI)之前,应最大限度地使用抗心绞痛药物治疗。但在当代实践中的应用程度尚不清楚。我们的目的是描述一个全国性综合医疗系统在 CTO PCI(CTO PCI)术前 3 个月内使用抗心绞痛治疗和压力测试的频率和变异性:我们确定了退伍军人事务医疗保健系统内 2012 年 1 月至 2018 年 9 月期间尝试进行 CTO PCI 的患者。患者按 CTO PCI 前的管理进行分类:存在≥2 个反向血管、进行过压力测试,以及在尝试 PCI 后 3 个月内存在≥2 个反向血管并进行过压力测试。采用多变量逻辑回归和反倾向加权法进行调整后再进行裁剪,并计算中位赔率以估计变异性:在 4250 例尝试进行 CTO PCI 的患者中,40% 的患者接受了≥2 种抗心绞痛药物治疗,24% 的患者接受了术前压力测试。在研究期间,CTO PCI 前接受一种以上抗心绞痛药物治疗的几率没有变化(几率比 [OR],1.0 [95% CI,0.97-1.04]),而接受术前压力测试的几率有所下降(OR,0.97 [95% CI,0.93-0.99]),接受≥2 种抗心绞痛药物治疗和压力测试的几率没有变化(OR,0.98 [95% CI,0.93-1.04])。中位几率比(MOR)显示,不同医院(MOR,1.3 [95% CI,1.26-1.42])和不同操作者(MOR,1.35 [95% CI,1.26-1.63])在抗心绞痛治疗方面存在很大差异。同样,不同医院(MOR,1.68[95% CI,1.58-1.81])和不同操作者(MOR,1.80[95% CI,1.56-2.38])的术前压力测试差异也很大:结论:仅有不到一半的患者在进行CTO PCI前接受了指南推荐的治疗,而治疗部位和操作者存在显著差异。这些研究结果表明,有机会减少CTO PCI术前管理的变异性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Contemporary Management Before Chronic Total Occlusion Percutaneous Coronary Interventions: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.

Background: Guidelines recommend maximal antianginal medical therapy before attempted coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The degree to which this occurs in contemporary practice is unknown. We aimed to characterize the frequency and variability of preprocedural use of antianginal therapy and stress testing within 3 months before PCI of CTO (CTO PCI) across a nationally integrated health care system.

Methods: We identified patients who underwent attempted CTO PCI from January 2012 to September 2018 within the Veterans Affairs Healthcare System. Patients were categorized by management before CTO PCI: presence of ≥2 antianginals, stress testing, and ≥2 antianginals and stress testing within 3 months of PCI attempt. Multivariable logistic regression and inverse propensity weighting were used for adjustment before trimming, with median odds ratios calculated for variability estimates.

Results: Among 4250 patients undergoing attempted CTO PCI, 40% received ≥2 antianginal medications and 24% underwent preprocedural stress testing. The odds of antianginal therapy with more than one medication before CTO PCI did not change over the years of the study (odds ratio [OR], 1.0 [95% CI, 0.97-1.04]), whereas the odds of undergoing preprocedural stress testing decreased (OR, 0.97 [95% CI, 0.93-0.99]), and the odds of antianginal therapy with ≥2 antianginals and stress testing did not change (OR, 0.98 [95% CI, 0.93-1.04]). Median odds ratios (MOR) showed substantial variability in antianginal therapy across hospital sites (MOR, 1.3 [95% CI, 1.26-1.42]) and operators (MOR, 1.35 [95% CI, 1.26-1.63]). Similarly, preprocedural stress testing varied significantly by site (MOR, 1.68 [95% CI, 1.58-1.81]) and operator (MOR, 1.80 [95% CI, 1.56-2.38]).

Conclusions: Just under half of patients received guideline-recommended management before CTO PCI, with significant site and operator variability. These findings suggest an opportunity to reduce variability in management before CTO PCI.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Circulation. Cardiovascular Quality and Outcomes
Circulation. Cardiovascular Quality and Outcomes Medicine-Cardiology and Cardiovascular Medicine
CiteScore
9.80
自引率
2.90%
发文量
357
期刊介绍: Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.
期刊最新文献
Association Between Life's Essential 8 Cardiovascular Health Metrics With Cardiovascular Events in the Cardiovascular Disease Lifetime Risk Pooling Project. Clinician Decision Support Tools: Advances in Lipid-Lowering Treatment Intensification. Beyond the Methods: Economic Stability and Cardiovascular Health. Mapping Geographic Proximity to Cardiologists Across the United States. Determinants and Outcomes Associated With Skilled Nursing Facility Use After Coronary Artery Bypass Grafting: A Statewide Experience.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1