Racial/ethnic differences persist in treatment choice and outcomes in isolated intervention for coronary artery disease.
Racial/ethnic differences persist in treatment choice and outcomes in isolated intervention for coronary artery disease.
复制标题
冠状动脉疾病的孤立干预治疗选择和结果方面仍然存在种族/民族差异。
DOI：
10.1016/j.jtcvs.2022.01.034
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Ghanta,RaviK
中科院分区：
文献类型：
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作者：
Zea-Vera,Rodrigo;Asokan,Sainath;Shah,RohanM;Ryan,ChristopherT;Chatterjee,Subhasis;WallJr,MatthewJ;Coselli,JosephS;Rosengart,ToddK;Kayani,WaleedT;Jneid,Hani;Ghanta,RaviK
目的研究发现冠状动脉疾病介入治疗策略存在种族/民族差异。我们调查了按人种/种族分层的冠状动脉疾病治疗选择（冠状动脉旁路移植术或经皮冠状动脉介入治疗）的趋势和结局。方法查询2002 - 2017年全国住院患者样本中接受隔离冠状动脉旁路移植术或经皮冠状动脉介入治疗的患者。结局按人种/种族（白色、非裔美国人、西班牙裔、亚裔）分层。多变量逻辑回归评估了种族/民族与接受冠状动脉旁路移植术与经皮冠状动脉介入治疗、住院死亡率和费用之间的相关性。结果在15年的时间里，进行了2，426，917例隔离冠状动脉旁路移植术和7，184，515例经皮冠状动脉介入治疗。与白色患者相比，非裔美国人患者更年轻（62 [四分位距，53 - 70] vs 66 [四分位距，57 - 75]岁），更可能有医疗补助保险（12.2% vs 4.4%），并且有更多的合并症（Charlson-Deyo指数，1.9 ± 1.6 vs 1.7 ± 1.6）（所有P <0.05）。01）。在对患者合并症、急性心肌梗死、保险状况和地理因素进行调整后，非裔美国人是所有种族/民族中最不可能接受冠状动脉旁路移植术的（比值比，0.76; P <0.05）。01），在整个研究中保持一致的趋势。非裔美国患者在冠状动脉旁路移植术后有更高的风险调整死亡率（比值比，1.09; P <0.05）。01）。人种/种族与经皮冠状动脉介入治疗后死亡率增加无关。非裔美国患者冠状动脉旁路移植术的住院费用较高（+5816美元; P <. 01)经皮冠状动脉介入治疗（+$856; P <. 01)在控制混杂因素后。结论在这项当代国家分析中，冠状动脉旁路移植术与经皮冠状动脉介入治疗冠心病的风险调整频率因种族/民族而异。非裔美国患者接受冠状动脉旁路移植术的几率较低，结局较差。这些差异的原因值得进一步调查，以确定减少潜在差异的机会。
Objective Studies have noted racial/ethnic disparities in coronary artery disease intervention strategies. We investigated trends and outcomes of coronary artery disease treatment choice (coronary artery bypass grafting or percutaneous coronary intervention) stratified by race/ethnicity. Methods We queried the National Inpatient Sample for patients who underwent isolated coronary artery bypass grafting or percutaneous coronary intervention (2002-2017). Outcomes were stratified by race/ethnicity (White, African American, Hispanic, Asian). Multivariable logistic regression evaluated associations between race/ethnicity and receiving coronary artery bypass grafting versus percutaneous coronary intervention, in-hospital mortality, and costs. Results Over the 15-year period, 2,426,917 isolated coronary artery bypass grafting surgeries and 7,184,515 percutaneous coronary interventions were performed. Compared with White patients, African American patients were younger (62 [interquartile range, 53-70] vs 66 [interquartile range, 57-75] years), were more likely to have Medicaid insurance (12.2% vs 4.4%), and had more comorbidities (Charlson-Deyo index, 1.9±1.6 vs 1.7±1.6)(all P<. 01). After adjustment for patient comorbidities, presence of acute myocardial infarction, insurance status, and geography, African Americans were the least likely of all racial/ethnic groups to undergo coronary artery bypass grafting (odds ratio, 0.76; P<. 01), a consistent trend throughout the study. African American patients had higher risk-adjusted mortality after coronary artery bypass grafting (odds ratio, 1.09; P<. 01). Race/ethnicity was not associated with increased mortality after percutaneous coronary intervention. African American patients had higher hospitalization costs for coronary artery bypass grafting (+ $5816; P<. 01) and percutaneous coronary intervention (+ $856; P<. 01) after controlling for confounders. Conclusions In this contemporary national analysis, risk-adjusted frequency of coronary artery bypass grafting versus percutaneous coronary intervention for coronary artery disease differed by race/ethnicity. African American patients had lower odds of undergoing coronary artery bypass grafting and worse outcomes. Reasons for these differences merit further investigation to identify opportunities to reduce potential disparities.