中国县域医院心血管专科冠状动脉复杂病变介入治疗能力现状——基于2021年304家县级医院的调研  

Current status of percutaneous coronary intervention for complex coronary artery lesions among county medical institutions in China——based on a survey of 304 county-level hospitals in 2021

作　　者：刘耀琨 郑博[1,2] 陈楚云 范芳芳[1,2] 张岩[1,2] 丁燕生[1,2] 李建平[1,2] 霍勇[1,2] LIU Yao-kun;ZHENG Bo;CHEN Chu-yun;FAN Fang-fang;ZHANG Yan;DING Yan-sheng;LI Jian-ping;HUO Yong(Department of Cardiology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院心血管内科,北京100034 [2]北京大学第一医院心血管疾病研究所

出　　处：《中国介入心脏病学杂志》2022年第8期596-600,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的 明确我国县域医院心血管专科冠状动脉复杂病变介入治疗能力现状及其与胸痛中心建设的关系,为未来提升县域医院冠心病介入整体能力和胸痛中心建设提供依据。方法 对全国各省/直辖市/自治区的县级医院心血管专科能力(包括冠状动脉复杂病变介入能力)情况进行问卷调查。以胸痛中心建设状态进行分组,评估包括慢性完全闭塞(CTO)病变、左主干病变、分叉病变以及接受旋磨治疗的严重钙化病变在内的冠状动脉复杂病变介入治疗能力与胸痛中心认证状态之间的关系。结果 调研涵盖除港澳台外的全国31个省/直辖市/自治区共304家县级医院,分析了其中203家具有冠状动脉介入诊疗能力的医院的数据,其中已认证基层版胸痛中心的医院共77家(37.93%),已认证标准版胸痛中心31家(15.27%),余95家(46.80%)未认证或未申请胸痛中心。在这203家医院中,143家(70.44%)可进行冠状动脉复杂病变的介入治疗,开展CTO病变、左主干病变、分叉病变及冠状动脉旋磨术的比例分别为39.90%、49.26%、52.22%、26.60%。已认证标准版胸痛中心的医院较已认证基层版和未认证及未申请胸痛中心的医院开展CTO病变和分叉病变介入治疗的比例显著更高(P=0.049,P=0.011)。多因素分析显示,已认证标准版胸痛中心组开展CTO病变(OR 2.58,95%CI 1.05~6.33,P=0.038)和同时开展CTO病变/左主干病变/分叉病变/冠状动脉旋磨技术(OR 6.08,95%CI 1.45~25.51,P=0.014)的比例显著高于未认证及未申请组。结论 目前我国县域医院中有相当比例可以开展冠状动脉复杂病变介入治疗,且已认证标准版胸痛中心的县域医院冠状动脉复杂病变介入治疗能力更强。这为进一步推动县域医院冠心病介入诊疗能力及胸痛中心的建设和发展提供了合理的依据。Objective The current study is aim to describe the status of percutaneous coronary intervention(PCI) for complex coronary artery lesions among County Medical Institutions and to investigate the correlation between the status of complex PCI and the construction of chest pain centers(CPCs)in China,providing a basis for improving the overall ability of PCI and the construction of CPCs in the future. Methods A questionnaire was conducted about the cardiovascular department capacity(including the capacity of PCI for complex coronary lesions)among the county medical institutions from provinces/municipalities/autonomous regions of China. The ability of PCI for complex coronary artery lesions, including chronic total occlusion(CTO),left main coronary artery, bifurcation and severe calcified lesion treated with rotablator atherectomy, were compared among groups under different CPCs construction process. Results A total of 304 hospitals were enrolled from 31 provinces/municipalities/autonomous regions in China except for Taiwan, Hong Kong and Macao. We analyzed the data of 203 hospitals(66.78% of 304)with capability of PCI, among which 77 hospitals(37.93%)have been certified as CPCs of basic version,31 hospitals(15.27%) have passed the CPC accreditation of standard version, and 95 hospitals(46.80%)have not been certified or applied for CPCs. One hundred and fourty three hospitals(70.44%)were able to conduct PCI for coronary complex lesions. The proportion of investigated hospitals with capability of PCI for CTOs, left main lesions, bifurcation lesions and rotational atherectomy for coronary calcification were 39.90%,49.26%,52.22%,and 26.60%,respectively. Moreover, the proportion of coronary complex lesions intervention was greater in the CPCs certified as standard version than the other hospitals. Significant differences were observed among groups with PCI abilities for CTOs(58.06% vs. 32.47% vs. 40.00%,P=0.049) and bifurcation lesions(64.52% vs. 38.96% vs. 58.95%,P=0.011). Multivariate analysis showed that the proportion

关 键 词：冠状动脉复杂病变 经皮冠状动脉介入治疗 胸痛中心 县域医院 

分 类 号：R541[医药卫生—心血管疾病]