| Background:With the increase of the aging population and improvement of standard living, coronary atherosclerotic heart disease has gradually become one of the biggest threats to the health of human and affected people’s living standards as well. Treatment of coronary heart disease is also developed from a single drug therapy to combination therapy of drugs and revascularization procedure. In the past 20 years, Percutaneous Coronary Intervention (PCI) has been developed rapidly. In the past 10 years, China has gained progress in the coronary stent implantation field. Coronary heart disease primary prevention and secondary prevention have been popular and strengthened. But it is not clear whether or not there are changes in the clinical features of patients undergoing PCI, stenting indications, complications of the procedure and efficacy of PCI, in the past 10 years.The purpose of this study is to look at the trends of demographic characteristics, risk factors, complications, clinical diagnosis and treatment characteristics, coronary artery lesions, stent implantation, MACCE event rate, economic indicators in patients with PCI during the past decade.Methods:This study recruided all patients with stent implantation in our hospital in 2003 and 2013, These patients were divided according to the time of admission. There were 240 cases in 2003 group and 1254 cases in 2013 group. In this study, these 1494 cases were described carefully, including the clinical data, auxiliary examination results and medical records. The basic situation, clinical baseline,risk factors, complications, clinical diagnosis and treatment characteristics, coronary artery lesions, stent implantation, MACCE event rate, economic indicators of the patients undergoing PCI in 2003 and 2013were compared. At the same time, due to differences in the clinical characteristics of elderly patients, we did a subgroup analysis for elderly patients (age≥70 years). In the statistical analysis of the data, for the measurement data using mean±standard deviation, ie x±s; Statistical analyzes were performed using SPSS 19.0 software. T test was used to compare the mean value of the measurement data between the two group, for comparing the count data, chi-square test or Fisher’s exact test were used, rank sum test was used for grade data compare. p<0.05 is considered to be statistical significant difference.Results:Compared with that in 2003 group (240 cases), the number of patients undergoing PCI (1254 cases) in 2013 group increased significantly. The proportion of patients underwent emergency coronary intervention in 2013 was 9.9%(124/1254), significantly lower than that (21.7%(52/240) in the 2003 group (p<0.01). In 2003, majority of the patients undergoing PCI (78.3%(188/240))) were Shanghai residents, this ratio is decreased significantly to 54.0%(677/1254) in 2013 (p<0.01). There was no significant difference between the two groups in patients’age, gender ratio (p> 0.05). However, the majority of patients were male, in 2013 and in 2003 groups, the male patients accounted for 70.0% and 74.2%, respectively. There was no significant difference between those two groups of patients in hypertension, and diabetes, dyslipidemia ratio (p> 0.05). However, the smokers in group of 2013 were significantly decreased (35.7% and 51.9%, respectively, p<0.05). In 2013, the proportion of the patients who had a history of coronary artery intervention was 15.9%(200/1254), which was significantly higher than that in 2003 group of patients ((6.7%,16/240, P<0.01). History of stroke occurred in 3.9% PCI patients in 2013, which is lower than that in 2003 group(10.4%, P<0.01). The proportion of patients suffered from gastrointestinal bleeding was 2.2% in 2013, which is significantly lower than that in 2003(7.9%,P<0.01). There were some differences in the main diagnosis(p<0.05). The ratio of patients with unstable angina was significantly higher in 2013than that in 2003 (59.6% vs 49.6%, P<0.01). The proportion of patients with myocardial infarction in 2013, was slightly decreased compared with that in 2003 (24.3% vs 35.4%, P<0.01). All of the selected patients were using NYHA or Killips to classify the cardiac function. The cardiac function of patients in 2013 was better than that in group of 2003, regardless of which classification method was used (P<0.01). Laboratory tests and echocardiography results in admission were also analyzed. Compared with the 2003 group, patients of 2013 group had lower serum levels of total cholesterol, potassium and troponin (P<0.01), had a higher serum levels of HDL-C and urea(P<0.01). There was no significant difference between the two groups of patient in creatinine, uric acid, triglycerides, LDL-C, FS, and LVEF (p> 0.05). In the results of coronary angiography, though there was no statistical difference between the two groups’Gensini score, but the proportion of patients with complex coronary lesions was significantly higher than that of the group of 2003(53.5% vs 35.8%,P<0.01). The proportion of multiple-vessel disease in 2013 was increased from 26.3% in 2003 to 45.1% in 2013 (P<0.01). Meanwhile, the proportion of left main disease was increased to 6.3% from the past 2.1% (P<0.01). In 2013, the average number of stents implanted was 1.64±0.843, this number was significantly increased compared with that in 2003(1.38±0.615,P<0.01). The total length of stents per patients in 2013 was also increased to 40.20±24.12mm from that in 2003 (27.30±14.95mm,P<0.01). The proportion of domestic stent implanted increased significantly from 8.48% in 2003 to 72.75% in 2013 (P<0.01). The incidence of postoperative complications decreased significantly from 20.4% in 2003 to 8.1% in 2013(P<0.01). the puncture site bleeding incidence decreased from 13.3% to 3.8%(P <0.01). In 2013, the survival rate of patients in hospital was 99.7%, increased significantly compared with 98.3% in 2003 (P<0.05). There was no significant difference in MACCE rate between the two groups (1.5% in 2013 and 2.1% in 2003,respectively, p> 0.05). From the economic point of views, the total hospitalization costs for each patient was 56669.28 ±144052.74yuan in 2013 and 60749.51±36762.82yuan in 2003(p>0.05). However, total time stayed in hospital was decreased significantly from 12.55±6.33 days in 2003 to 6.45±4.40 days in 2013(p<0.05). Days stayed in CCU decreased significantly as well from 6.44±5.90 days to 1.57±2.85 days (p<0.05).The proportion of elderly patients (≥70 years) undergoing coronary stent implantation account for 46.25% in 2003 and 47.53% in 2013, respectively (P>0.05).Subgroup analysis for these elderly patients showed that male patients accounted for 57.3% in 2013, which was lower significantly as compared with 70.3% in 2003(p<0.01). The ratio of patients with myocardial infarction as main diagnosis decreased 35.1% to 23.5%(p<0.05). As compared with that in 2003, the elderly patients in 2013 had lower serum levels of total cholesterol, LDL-cholesterol (p<0.01),and higher HDL-C level (p<0.01). The proportion of patients with LVEF less than 50% decreased from 13.5% in 2003 to 4.7% in 2013(P<0.01).From the economic point of views, the total hospitalization costs for each elderly patient decreased significantly from 63377.82±46315.00 yuan in 2003 to 54213.03±36080.74 yuan in 2013 (p<0.05), Other comparative parameters were roughly the same to the whole study group.Summary:1. In the past 10 years, the number of PCI in Changhai Hospital of Shanghai has significantly increased. However, the proportion of emergency PCI patients and the proportion of shanghai residents were significantly reduced.2. Composition of patients’ age and gender, and proportion of high blood pressure, diabetes and dyslipidemia did not change significantly, but the proportion of smokers was significantly reduced.3. The proportions of patients with unstable angina, multiple-vessel disease, left main disease and complex coronary lesions were increased. The proportion of patients with myocardial infarction decreased4. The number and length used in the stents significantly increased; Domestic stent usage increased significantly5. Intraoperative and postoperative complications and mortality were significantly reduced, the overall incidence of MACCE was not significantly changed.6. The total time of patients stay in hospital and CCU was significantly shorter, and the total hospital cost decreased.7. Compare the eldlery patients in 2013 and eldlery patients in the 10 years ago; PCI patients in 2013 have higher average age, reducing the proportion of men, with lower cholesterol levels, total cost of hospitalization.Conclusion:Some Changes has taken place during the past decade in the PCI patient’s characteristic and PCI procedure. Patients undergoing PCI in recent year had lower proportion of smoker with no change in other risk factors. Though the proportion of patients with unstable coronary disease and complex coronary lesions increased, the number and length of stents implanted for each patients increased as well, complications and mortality during and post procedure were significantly decreased. Meanwhile, due to the increased usage of domestic stent, shorter stay in hospital and CCU, the total hospital cost for PCI patients decreased. |
PDF Full Text Request