Dissertation/ Thesis
Medical Outcome and Utilization in Dialysis-Dependent End-Stage-Renal Disease Patients with Coronary Artery Disease：DES v.s. Coronary Artery Bypass Graft Surgery
| العنوان: | Medical Outcome and Utilization in Dialysis-Dependent End-Stage-Renal Disease Patients with Coronary Artery Disease：DES v.s. Coronary Artery Bypass Graft Surgery |
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| Alternate Title: | 塗藥支架與繞道手術在冠狀血管疾病的臨床療效與醫療耗用的比較：以末期腎臟疾病接受透析治療患者為例 |
| المؤلفون: | wei-chih Chiu, 邱威智 |
| Thesis Advisors: | King-Teh Lee, 李金德 |
| سنة النشر: | 2017 |
| المجموعة: | National Digital Library of Theses and Dissertations in Taiwan |
| الوصف: | 105 Background： In Taiwan，the incidence and prevalence rate of end stage renal disease（ESRD）increase gradually year by year。Data from prospective studies support that cardiovascular diseases，including coronary artery disease（CAD），remains the most common cause of death（45%）in patient with ESRD。Percutaneous coronary intervention（PCI）or coronary artery bypass surgery （CABG）should be performed in patients with severe stenotic lesions of coronary artery。However，the efficiency and safety of such a strategy has not been studied so far in hemodialysis-dependence patients。In my study，I assessed the optimal strategy and compared drug-eluting stent（DES）and CABG for treating coronary artery disease in clinical effect and medical utilities。 Methods： This cross-sectional cohort study obtained from national health insurance research database and restricted the period between 2007 and 2013。The goal in this analysis was to investigate in patients with dialysis-dependence whether the favorable outcome in DES（134 patients）and CABG（88 patients）persisted over 7 years of follow-up included CAD associated re-admission、revascularization、mortality rate、stroke、myocardial infarction，which were composition of major adverse cardiac and cerebrovascular event（MACCE）。Medical utility analyzed the length of stays（LOS）and hospital expenses in the index intervention。Binary logistic regression analysis was used for prognostic analysis of MACCE。 Results： The risk of CAD associated re-admission during first year after procedure of CABG and DES implantation was no difference（OR = 0.91，p = 0.4），the following 6 years with same result。The event-free rate of any coronary revascularization after CABG was marked higher after DES implantation persisted over 7 years of follow-up（log-rank p < 0.0001）。When compared with CABG, there was increased all-cause mortality-free rate（log-rank p = 0.003）in patients who underwent PCI with DES in long-term follow up；in-hospital mortality rate was significant higher after CABG（15.9% vs 2.2%）。In patients underwent CABG or PCI，cumulative 7-year overall myocardial infarction，stroke and composite MACCE had similar risk。 Data from my study of DES compared with CABG has showed significant reduction in length of stay（CABG 36.1 39.9 vs DES 10.7 20.8 day，p < 0.01），T ＝ 5.5（p < 0.001）。Log transformation（Log10）was used in total hospital expenses which existed great variation between each group and small sample size。Compared with DES，average total cost in CABG was significantly higher on discharge（5.6 ± 0.5 v.s. DES 5.2 ± 0.3，t = 6.43，p < 0.001）。PCI with DES implantation was showed to be cost-saving procedure compared with CABG in index procedure admission。 MACCE，composite of revascularization、myocardial infarction、death and stroke，means whole adverse events associated with coronary artery disease。In our study the correlation factors included：female，single-vessel-disease and the most important - myocardial infraction status in index procedure。 Conclusion： PCI with DES implantation is clinical and economically attractive revascularization strategy compared with CABG in this high-risky group |
| Original Identifier: | 105KMC05777014 |
| نوع الوثيقة: | 學位論文 ; thesis |
| وصف الملف: | 81 |
| الاتاحة: | http://ndltd.ncl.edu.tw/handle/19656741121872193783 |
| رقم الانضمام: | edsndl.TW.105KMC05777014 |
| قاعدة البيانات: | Networked Digital Library of Theses & Dissertations |
| الوصف غير متاح. |