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    《美三大學(xué)會(huì)發(fā)布新版PCI專家共識(shí)》內(nèi)容簡(jiǎn)介：

    2014年3月17日，美國(guó)SCAI/ACC/AHA三大學(xué)會(huì)在線發(fā)布了沒(méi)有現(xiàn)場(chǎng)外科手術(shù)支持的經(jīng)皮冠狀動(dòng)脈介入（PCI）專家共識(shí)的更新文件。該共識(shí)文件（指南）對(duì)過(guò)去十年中PCI的進(jìn)展進(jìn)行了回顧，提出了多項(xiàng)新的建議，是對(duì)2007年SCAI文件的更新，而后者是該領(lǐng)域的第一個(gè)共識(shí)文件。該文件同時(shí)發(fā)表于《Catheterization & Cardiovascular Interventions》、《the Journal of the American College of Cardiology》和《Circulation》。

    指南的主要制訂者之一Gregory Dehmer博士在新聞發(fā)布會(huì)上指出，新的推薦旨在為患者提供優(yōu)質(zhì)醫(yī)療和護(hù)理服務(wù)的同時(shí)增加安全性，在沒(méi)有現(xiàn)場(chǎng)外科手術(shù)支持的情況下，PCI應(yīng)該怎么做，如何做的更好。Dehmer等寫(xiě)道，自2007年指南發(fā)布后共有11項(xiàng)原始研究和3項(xiàng)Meta分析發(fā)表。同一時(shí)期，美國(guó)允許進(jìn)行擇期和急診PCI的州增加了60%,達(dá)到了45個(gè)；在沒(méi)有心臟外科在場(chǎng)（PCI without on-site surgery）的情況下禁止PCI的州從10個(gè)減少到1個(gè)。

    《美三大學(xué)會(huì)發(fā)布新版PCI專家共識(shí)》內(nèi)容預(yù)覽：

    4SCAI/ACC/AHA 2014 PCI

    Without On-Site Surgery ECDhad no on-site surgery, and among these, 65% （282 facilities） had an annual case volume of≤200 PCI procedures.Across the US, PCI without on-site surgery has increased since 2007. The writingcommittee assessed the current use of PCI without on-site surgery from a survey of ACCGovernors for each state, data from industry sources and direct contact with physicians invarious states （Fig. 2）。

    Currently, 45 states allow both primary and elective PCI without on-site surgery, 4 states allow only primary PCI without on-site surgery, and 1 state prohibitsPCI without on-site surgery. PCI without on-site surgery is regulated by the State Departmentof Health in 34 states but is unregulated in the remaining 16 states.

    Elective PCI without on-site surgery was allowed at selected facilities in 9 states but only as part of statewidedemonstration projects or to allow participation in the Cardiovascular Patient OutcomesResearch Team （CPORT） Nonprimary PCI （CPORT-E） trial [9]. Since the conclusion ofCPORT-E, the use of PCI without on-site surgery is being revaluated in several of thesestates. PCI without on-site surgery is currently performed in 19 of the 65 cardiaccatheterization laboratories within the Veterans Health Administration [10].Recent Literature on PCI Without On-site SurgerySince 2006, 11 original studies and 3 meta-**yses on the topic of PCI without on-sitesurgery have been identified by a computerized systematic literature search using Medline（PubMed and Ovid） and Cochrane Databases [9,11–23].Primary PCI without on-site surgery. Seven studies and 2 meta-**yses of primary PCIshowed no difference for in-hospital or 30-day mortality between sites with and without on-site surgery （Table 1）。 None of the individual studies examining the occurrence of emergencyCABG surgery after primary PCI showed a difference between sites with and without on-sitesurgery. However, 1 meta-**ysis showed that sites without on-site surgery had a lowerDownloaded From: http://content.onlinejacc.org/ on 03/17/2014gui

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