Association between Race and Perioperative Outcomes after Carotid Endarterectomy for Asymptomatic Carotid Artery Stenosis in NSQIP.
Association between Race and Perioperative Outcomes after Carotid Endarterectomy for Asymptomatic Carotid Artery Stenosis in NSQIP.
复制标题
NSQIP 中无症状颈动脉狭窄颈动脉内膜切除术后种族与围手术期结果之间的关联。
DOI：
10.1097/xcs.0000000000000016
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发表时间：
2022-01-01
影响因子：
5.2
通讯作者：
Hicks, Caitlin W.
中科院分区：
文献类型：
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作者：
Mallela, Deepthi P.;Canner, Joseph K.;Zarkowsky, Devin S.;Haut, Elliott R.;Abularrage, Christopher J.;Hicks, Caitlin W.
先前的研究表明，与白人患者相比，黑人患者在下肢血运重建术后的预后更差。然而，种族与颈动脉内膜切除术（CEA）结果的关系尚未得到很好的描述。本研究的目的是比较黑人和白人无症状颈动脉狭窄患者的围手术期预后。纳入ACS-NSQIP靶向血管数据库（2011-2019）中所有因无症状颈动脉狭窄而行CEA的患者。采用多变量logistic回归调整年龄/性别、合并症和疾病特征，比较黑人和白人患者围手术期（30天）的结果。在16764例无症状CEA患者中，95.2% （N = 15960）为白人，4.8% （N = 804）为黑人。与白人患者相比，黑人患者稍年轻（平均年龄71.4±0.1岁vs 69.9±0.3岁，P < 0.001），且颈动脉高度狭窄发生率更高（79.5% vs 74.0%, P = 0.001）。黑人患者的合并症包括高血压、糖尿病、肾病、充血性心力衰竭和冠状动脉疾病都更为普遍（p≤0.01）。黑人患者围手术期粗卒中（2.4% vs 1.3%, p = 0.007）和卒中/死亡（2.6% vs 1.4%, p = 0.003）较高，但心肌梗死（1.7% vs 1.5%, p = 0.67）和死亡（0.4% vs 0.2%, p = 0.12）相似。在调整各组间基线差异后，黑人患者围手术期卒中（优势比1.66,95% CI 1.01至2.73）和卒中/死亡（优势比1.75,95% CI 1.10至2.81）的风险仍显著高于白人患者。与白人患者相比，接受CEA治疗无症状颈动脉狭窄的黑人患者有更严重的狭窄、更多的合并症和更差的围手术期预后。总的来说，我们的数据表明，基于种族的无症状颈动脉狭窄的治疗和结果存在实质性差异。
Previous studies have documented that Black patients have worse outcomes after lower extremity revascularization procedures compared with White patients. However, the association of race on carotid endarterectomy (CEA) outcomes is not well described. The aim of this study was to compare perioperative outcomes of CEA for Black vs White patients with asymptomatic carotid artery stenosis. All patients who underwent CEA for asymptomatic carotid stenosis in the ACS-NSQIP targeted vascular database (2011–2019) were included. Perioperative (30-day) outcomes were compared for Black vs White patients using multivariable logistic regression adjusting for age/sex, comorbidities, and disease characteristics. Of 16,764 asymptomatic CEA patients, 95.2% (N = 15,960) were White and 4.8% (N = 804) were Black. Black patients were slightly younger (mean age 71.4 ± 0.1 vs 69.9 ± 0.3 years, P < 0.001) and more frequently had high-grade carotid artery stenosis compared to White patients (79.5% vs 74.0%, p = 0.001). Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients (p ≤ 0.01). Crude perioperative stroke (2.4% vs 1.3%, p = 0.007) and stroke/death (2.6% vs 1.4%, p = 0.003) were higher for Black patients, but myocardial infarction (1.7% vs 1.5%, p = 0.67) and death (0.4% vs 0.2%, p = 0.12) were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke (odds ratio 1.66, 95% CI 1.01 to 2.73) and stroke/death (odds ratio 1.75, 95% CI 1.10 to 2.81) remained significantly higher for Black patients compared with White patients. Black patients undergoing CEA for asymptomatic carotid artery stenosis had more severe stenosis, more comorbidities, and worse perioperative outcomes compared to White patients. Overall, our data suggest substantial differences in the treatment and outcomes of asymptomatic carotid artery stenosis based on race.