Racial Disparities in the Utilization and Outcomes of TAVR TVT Registry Report
Racial Disparities in the Utilization and Outcomes of TAVR TVT Registry Report
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DOI：
10.1016/j.jcin.2019.03.007
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发表时间：
2019-05-27
影响因子：
11.3
通讯作者：
Vemulapalli, Sreekanth
中科院分区：
文献类型：
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作者：
Alkhouli, Mohamad;Holmes, David R., Jr.;Vemulapalli, Sreekanth
目的：本研究旨在评估经导管主动脉瓣置换术（TAVR）的表现和结果的种族差异。背景：心血管疾病的种族差异已经得到了很好的描述。手术主动脉瓣置换术中观察到的种族差异是否也存在于TAVR中尚不清楚。方法在2011年11月至2016年6月期间接受TAVR的患者在美国心脏病学会/胸外科学会/经导管瓣膜治疗登记处被确定。我们描述了种族分布、经风险调整的住院发病率和死亡率按种族分层。我们通过与医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）索赔的联系评估了一部分患者的1年预后。结果在70221例纳入的患者中，白人占91.3%，黑人占3.8%，西班牙裔占3.4%，亚洲/美洲原住民/太平洋岛民占1.5%。这表明与非白人患者在人口中的比例相比，非白人患者的代表性明显不足。在风险调整后，4个种族组在住院死亡率、心肌梗死、中风、大出血、血管并发症或新起搏器需求方面没有差异。在29,351名与医疗保险和医疗补助服务中心相关的患者中，黑人和西班牙裔患者的1年调整死亡率与白人相似，但亚裔/美洲原住民/太平洋岛民患者的1年调整死亡率较低（调整风险比：0.71；95%可信区间：0.55至0.92;p = 0.028）。与白人相比，黑人和西班牙裔患者的心力衰竭住院率更高（校正风险比：1.39；95%可信区间：1.16至1.67;p < 0.001；校正风险比：1.37；95%可信区间：1.13至1.66;p = 0.004）。在对社会经济地位进行额外的风险调整后，这些差异仍然存在。结论：少数种族在美国接受TAVR的患者中代表性不足，但其调整后的30天和1年临床结果与白人相当。（J Am Coll Cardiol Intv 2019; 12: 936-48） (c) 2019由Elsevier代表美国心脏病学会基金会出版。
OBJECTIVES This study sought to evaluate racial disparities in the performance and outcomes of transcatheter aortic valve replacement (TAVR). BACKGROUND Racial disparities in cardiovascular diseases are well described. Whether the racial disparities observed in surgical aortic valve replacement also exist with TAVR remains unknown. METHODS Patients undergoing TAVR between November 2011 and June 2016 were identified in the American College of Cardiology/Society of Thoracic Surgeons/Transcatheter Valve Therapy Registry. We described the racial distribution, and the risk-adjusted in-hospital morbidity, and mortality stratified by race. We evaluated 1-year outcomes in a subset of patients via linkage to Medicare (Centers for Medicare and Medicaid Services) claims. RESULTS Among the 70,221 included patients, 91.3% were white, 3.8% were black, 3.4% were Hispanic, and 1.5% were of Asian/Native American/Pacific Islander race. This represented significant underrepresentation of nonwhite patients compared with their proportion of the population. After risk-adjustment, there was no difference in the rates of in-hospital mortality, myocardial infarction, stroke, major bleeding, vascular complications, or new pacemaker requirements among the 4 racial groups. Among 29,351 patients with Centers for Medicare and Medicaid Services linkage, 1-year adjusted mortality rates were similar in blacks and Hispanics compared with whites, but lower among patients of Asian/Native American/Pacific Islander race (adjusted hazard ratio: 0.71; 95% confidence interval: 0.55 to 0.92; p = 0.028). Black and Hispanic patients had more heart failure hospitalizations compared with whites (adjusted hazard ratio: 1.39; 95% confidence interval: 1.16 to 1.67; p < 0.001; and adjusted hazard ratio: 1.37; 95% confidence interval: 1.13 to 1.66; p = 0.004, respectively). These differences persisted after additional risk-adjustment for socioeconomic status. CONCLUSIONS Racial minorities are underrepresented among patients undergoing TAVR in the United States, but their adjusted 30-day and 1-year clinical outcomes are comparable with those of white race. (J Am Coll Cardiol Intv 2019; 12: 936-48) (c) 2019 Published by Elsevier on behalf of the American College of Cardiology Foundation.