Outcomes of Asian-Americans Implanted With Left Ventricular Assist Devices: An Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Analysis.
Outcomes of Asian-Americans Implanted With Left Ventricular Assist Devices: An Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Analysis.
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DOI：
10.1016/j.hlc.2019.11.017
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发表时间：
2020-08
期刊：
影响因子：
--
通讯作者：
Drakos SG
中科院分区：
文献类型：
--
作者：
Taleb I;Wever-Pinzon J;Wang W;Koliopoulou A;Dranow E;Yu T;Yin L;McKellar SH;Stehlik J;Fang JC;Wever-Pinzon O;Selzman CH;Drakos SG
研究表明，亚洲人和白人在中风、冠状动脉疾病、心力衰竭、出血和血栓形成的倾向上存在差异。我们调查了与白人相比，使用耐用左心室辅助装置（LVAD）的亚裔美国人是否表现出不同的发病率和死亡率。我们前瞻性地分析了从机械辅助循环支持跨机构注册（INTERMACS）数据库中收集的数据，以比较亚洲人与白人LVAD植入后的结局。总共纳入了7，018名患者，其中130名被确定为亚裔美国人。亚裔美国人更年轻，体重指数更低，血清胆红素更高，白蛋白水平更低。在多变量回归模型中，两组之间的生存率没有差异。亚裔美国人的器械故障发生率较低，在调整多个因素后仍较低。主要安全性复合结局（包括大出血、大感染、卒中和器械故障）的校正风险显示两组之间无差异。尽管之前的研究报告了亚洲人心脏手术结局较差，但在本INTERMACS分析中，亚裔美国人的生存率和不良事件风险似乎与白色人相似。无论是在单变量模型中还是在调整多个临床因素后，亚裔美国人的器械故障发生率均较低。未来，需要对患有终末期心力衰竭和LVAD支持的亚裔美国人进行更大规模的研究，以证实这些结果。
Studies have indicated differences between Asians and Whites in their propensity for stroke, coronary artery disease, heart failure, bleeding and thrombosis. We investigated whether Asian-Americans on durable left ventricular assist devices (LVADs) exhibit differential morbidity and mortality when compared to Whites. We analysed prospectively collected data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database to compare the outcomes after LVAD implantation of Asians versus Whites. In total, 7,018 patients were included, 130 were identified as Asian-Americans. Asian-Americans were younger, had lower body mass index, higher serum bilirubin and lower albumin levels. In a multivariable regression model, there was no difference in survival between the two groups. Asian- Americans had lower incidence of device malfunction and after adjusting for multiple factors this remained lower. The adjusted risk of a major safety composite outcome including major bleeding, major infection, stroke and device malfunction, revealed no difference between the two groups. Although prior studies have reported worse cardiac surgery outcomes in Asians, in this INTERMACS analysis Asian-Americans appear to have similar survival and risk of adverse events as their White counterparts. The incidence of device malfunction was lower in the Asian-Americans, both in a univariate model and after adjusting for multiple clinical factors. Future, larger studies of Asian- Americans with end-stage heart failure and LVAD support are warranted to confirm these results.
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