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目的 比较直接经皮冠状动脉腔内成形术 (直接PCI)和补救PCI治疗急性心肌梗死 (AMI)的疗效和费用效果比。 方法 采用观察性对列研究的方法。连续选取 2 0 0 0年 1月 1日 2 0 0 1年 12月 31日天津医科大学第二医院心脏科直接PCI治疗的AMI患者 5 9例以及补救PCI治疗的患者 2 9例。比较两组患者住院期及随访期的临床疗效、费用及费用效果比。 结果 两组患者基线资料完全匹配。冠脉造影显示血管的情况无差别。虽然从入院到血管再通时间补救PCI组长于直接PCI组 (2 19 4 7min± 10 3 5 9min比 116 0 5min± 5 4 4 6min) (P =0 0 0 0 ) ,但PCI术成功率两组间无统计学差别。住院期间心衰、心绞痛、再发心梗、出血等的发生率 ,病死率 ,监护日及住院日均无统计学差异。随访期累计心衰的发生率直接PCI组为 13 6 0 % ,补救PCI组为 31 0 0 % (P =0 0 5 0 ) ;再发心梗、再入院、再次冠脉介入或搭桥手术的发生率及总病死率两组无统计学差异。住院费用和总费用 ,补救PCI组高于直接PCI组 ;心功能获益的费用效果比 ,直接PCI组优于补救PCI组。 结论 补救PCI与直接PCI相比 ,手术同样安全有效。但是 ,慢性期心衰的发生率补救PCI高于直接PCI,费用也高于直接PCI。费用效果比 ,直接PCI优于补救PCI。
Objective To compare the efficacy and cost-effectiveness of direct percutaneous transluminal coronary angioplasty (PCI) and salvage PCI for acute myocardial infarction (AMI). Methods The method of observational alignment was used. Continuous selection of January 1, 2000 2001 December 31, 2001 Second Hospital of Tianjin Medical Cardiology of cardiopulmonary bypass AMI patients 59 cases and PCI-treated patients 29 cases. The two groups of patients inpatient and follow-up clinical efficacy, cost and cost-effectiveness ratio. Results The baseline data of the two groups matched exactly. Coronary angiography showed no difference in blood vessel status. Although the length of time between admission and revascularization of the PCI group was shorter in the PCI group than in the PCI group (2 19 4 7 min ± 10 3 5 9 min vs. 116 0 5 min ± 5 4 4 6 min) (P = 0 0 0 0) No significant difference between groups. During hospitalization, heart failure, angina pectoris, recurrence of myocardial infarction, bleeding and so on, mortality, monitoring and hospitalization days were no significant difference. The cumulative incidence of heart failure during the follow-up period was 136.0% in the direct PCI group and 310.0% in the PCI group (P = 0 050); recurrent MI, rehospitalization, coronary intervention or bypass surgery The incidence and overall mortality did not differ between the two groups. Hospitalization costs and total costs were higher in the PCI rehab group than in the direct PCI reimbursement group. The cost benefit of cardiac benefit was better than in the PCI rehab group. Conclusion Remedy PCI is also safe and effective compared with direct PCI. However, the incidence of chronic heart failure to recover PCI is higher than direct PCI, and the cost is higher than that of direct PCI. Cost-effective, direct PCI better than remedial PCI.