Impact of access to coronary angiography and percutaneous coronary intervention on in-hospital and five-year mortality in patients with acute coronary syndrome:a propensity-matched cohort study in Thailand  

作　　者：Ponlagrit Kumwichar Jutatip Thungthong Tippawan Liabsuetrakul Hisateru Tachimori Mariko Hosozawa Eiko Saito Yuta Taniguchi Virasakdi Chongsuvivatwong Hiroyasu Iso 

机构地区：[1]Department of Epidemiology,Faculty of Medicine,Prince of Songkla University,Hat Yai,Songkhla,Thailand [2]National Health Security Office,Nonthaburi,Thailand [3]National Center for Global Health and Medicine,Institute for Global Health Policy Research,Tokyo,Japan [4]Endowed Course for Health System Innovation,Keio University School of Medicine,Tokyo,Japan

出　　处：《Global Health Research and Policy》2024年第1期61-70,共10页全球健康研究与政策(英文)

基　　金：Japan International Cooperation Agency via the Partnership Project for Global Health and Universal Health Coverage Phase 2(GLO+UHC Phase 2);Institute for Global Health Policy Research,Bureau of International Health Cooperation,and National Center for Global Health and Medicine(Grant No.20A06).

摘　　要：Background Coronary artery angiography(CAG)and percutaneous coronary intervention(PCI)are superior to non-invasive approaches in reducing mortality in patients with ST-segment elevation myocardial infarction(STEMI).How-ever,their efficacy remains uncertain in non-ST-elevation acute coronary syndromes(NSTE-ACS)and limited in low-resource settings.This study aimed to compare in-hospital and 5-year mortality rates between patients with a first event of STEMI and NSTE-ACS who underwent CAG and PCI and those with similar severity who did not undergo CAG and PCI.Methods A propensity-matched retrospective cohort study was conducted using population-based claims data of national universal coverage of Thailand for identification of patients with acute coronary syndromes.The mortal-ity of recruited patients was additionally linked to the national database of vital registration.Patients aged≥40 years who were hospitalized for STEMI and NSTE-ACS in 2017,with a focus on access to CAG and PCI were included.For each condition either STEMI or NSTE-ACS,patients who underwent CAG and PCI were matched to those who did not undergo using propensity score matching(PSM)to balance measured confounders,such as age,sex,and under-lying conditions.In-hospital mortality rate ratio and 5-year mortality were analyzed as measures.Results Through PSM,2,702 non-intervention STEMI patients were paired with an equal number of intervention patients,and similarly,5,072 non-intervention NSTE-ACS patients were matched with an equivalent group who received interventions.For patients with STEMI,the in-hospital mortality rate ratio(95%confidence interval(CI))for those who underwent CAG and PCI compared to those who did not was 30.1%(30.0%,30.2%).Similar trends were observed in patients with NSTE-ACS with a mortality rate of 34.7%(34.6%,34.8%).For the five-year mortality comparison,the hazard ratios(95%CI)of mortality after discharge were 0.55(0.50,0.62)for STEMI and 0.57(0.54,0.61)for NSTE-ACS cases.Conclusions Access to CAG and PCI was significantly as

关 键 词：Healthcare services Quality of care Access to care National database utilization 

分 类 号：R54[医药卫生—心血管疾病]