Distinctive Clinical Profile of Blacks Versus Whites Presenting With Sudden Cardiac Arrest.
Distinctive Clinical Profile of Blacks Versus Whites Presenting With Sudden Cardiac Arrest.
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DOI：
10.1161/circulationaha.115.015673
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发表时间：
2015-08-04
期刊：
影响因子：
37.8
通讯作者：
Chugh SS
中科院分区：
文献类型：
--
作者：
Reinier K;Nichols GA;Huertas-Vazquez A;Uy-Evanado A;Teodorescu C;Stecker EC;Gunson K;Jui J;Chugh SS
心脏骤停（SCA）是死亡率的主要原因，但在非白人中数据有限。识别基于种族的临床特征差异可能为改善SCA预防提供机会。在正在进行的俄勒冈州意外猝死研究（SUDS）中，前瞻性地确定了俄勒冈州波特兰市大都市区患有SCA的个体。在2002 - 2012年的病例中，按种族比较患者人口统计、逮捕情况和sca前的临床概况（临床病史，n = 126黑人，1262白人）。计算了负担评估阶段病例的发病率（2002 - 2005年；n = 1077）。与白人男性和女性（分别为84 / 10万和40 / 10万）相比，黑人男性和女性的年龄调整率高出两倍（分别为175 / 10万和90 / 10万）。与白人相比，黑人在SCA发生时比白人年轻60岁，并且骤停前糖尿病（52%对33%，p<0.0001）、高血压（77%对65%，p=0.006）和慢性肾功能不全（34%对19%，p<0.0001）的患病率更高。先前记录的冠状动脉疾病或左心室功能障碍没有种族差异，但黑人有更普遍的充血性心力衰竭（43%比34%，p=0.04），左心室肥厚（77%比58%，p=0.02）和更长的QT间期（QTc）（466±36比453±41，p=0.03）。在这个美国社区，黑人的SCA负担明显高于白人。患有SCA的黑人在逮捕前的危险因素患病率高于已建立的CAD，这为种族特异性预防提供了潜在的目标。
Sudden cardiac arrest (SCA) is a major contributor to mortality, but data are limited among non-whites. Identification of differences in clinical profile based on race may provide opportunities for improved SCA prevention. In the ongoing Oregon Sudden Unexpected Death Study (SUDS), individuals suffering SCA in the Portland, Oregon metropolitan area were identified prospectively. Patient demographics, arrest circumstances, and pre-SCA clinical profile were compared by race, among cases 2002 – 2012 (for clinical history, n = 126 blacks, 1262 whites). Incidence rates were calculated for cases from the burden assessment phase (2002 – 2005; n = 1077). Age-adjusted rates were two-fold higher among black men and women (175 and 90 per 100,000, respectively), compared to white men and women (84 and 40 per 100,000, respectively). Compared to whites, blacks were >6 years younger at the time of SCA and had a higher pre-arrest prevalence of diabetes (52% vs. 33%, p<0.0001), hypertension (77% vs. 65%, p=0.006), and chronic renal insufficiency (34% vs. 19%, p<0.0001). There were no racial differences in previously documented coronary artery disease or left ventricular dysfunction, but blacks had more prevalent congestive heart failure (43% vs. 34%, p=0.04), left ventricular hypertrophy (77% vs. 58%, p=0.02), and a longer QT interval (QTc) (466 ± 36 vs. 453 ± 41, p=0.03). In this US Community, the burden of SCA was significantly higher in blacks compared to whites. Blacks with SCA had a higher pre-arrest prevalence of risk factors beyond established CAD, providing potential targets for race-specific prevention.