Black patients present with more severe vascular disease and a greater burden of risk factors than white patients at time of major vascular intervention.
Black patients present with more severe vascular disease and a greater burden of risk factors than white patients at time of major vascular intervention.
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DOI：
10.1016/j.jvs.2017.06.089
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发表时间：
2018-03
影响因子：
4.3
通讯作者：
Society for Vascular Surgery Vascular Quality Initiative
中科院分区：
文献类型：
--
作者：
Soden PA;Zettervall SL;Deery SE;Hughes K;Stoner MC;Goodney PP;Vouyouka AG;Schermerhorn ML;Society for Vascular Surgery Vascular Quality Initiative
虽然许多研究已经证明了大血管手术后的种族差异，但很少有人确定这些差异的原因，而那些经常缺乏临床粒度的研究。因此，我们的目的是评价黑人和白色患者之间初始血管介入治疗的差异。我们在2009-2014年的血管质量倡议登记研究中确定了黑人和白色患者的初始颈动脉、腹主动脉瘤（AAA）和腹股沟下外周动脉（PAD）介入治疗。我们排除了非黑人或非白人患者以及西班牙裔、无症状PAD或既往同侧干预史的患者。我们比较了国家和地区干预时的基线特征和疾病严重程度。我们确定了76，372例患者（9%黑人），包括35，265例颈动脉（5%黑人），17，346例AAA（5%黑人）和23，761例PAD干预（18%黑人）。在所有的手术中，黑人患者更年轻，更可能是女性，并且有更多的胰岛素依赖型糖尿病、高血压、充血性心力衰竭、肾功能不全和透析依赖。黑人患者在AAA（62% vs. 69%，P <0.001）或PAD干预（61% vs. 67%，P <0.001）之前使用他汀类药物的可能性较小，并且在这些手术后出院时使用抗血小板和他汀类药物方案的可能性也较小（AAA：60% vs. 64%，P = 0.01; PAD：64% vs. 67%，P <0.001）。黑人患者的疾病更严重，包括症状性颈动脉疾病（36 vs. 31%，P < .001）、症状性/破裂AAA（27 vs. 16%，P < .001）和慢性肢体威胁性缺血（73 vs. 62%，P < .001）的比例更高。黑人患者在AAA修复术时更常并发髂动脉瘤（择期开放AAA修复术：46% vs. 26%，P <0.001;择期腹主动脉瘤腔内修复术：38% vs. 23%，P <0.001）。黑人患者在初次大血管手术时表现出更晚期的疾病。努力控制风险因素，及时识别和治疗动脉疾病，并优化黑人患者的医疗管理，可能会提供改善目前差距的机会。
While many studies have demonstrated racial disparities after major vascular surgery, few have identified the reasons for these disparities and those that did often lacked clinical granularity. Therefore, our aim was to evaluate differences in initial vascular intervention between black and white patients. We identified black and white patients' initial carotid, abdominal aortic aneurysm (AAA), and infrainguinal peripheral artery (PAD) interventions in the Vascular Quality Initiative registry from 2009-2014. We excluded non-black or non-white patients as well as those with Hispanic ethnicity, asymptomatic PAD, or a history of prior ipsilateral interventions. We compared baseline characteristics and disease severity at time of intervention on a national and regional level. We identified 76,372 patients (9% black), including 35,265 carotid (5% black), 17,346 AAA (5% black), and 23,761 PAD interventions (18% black). For all operations, black patients were younger, more likely female, and had more insulin-dependent diabetes, hypertension, congestive heart failure, renal dysfunction, and dialysis dependence. Black patients were less likely to be on a statin prior to AAA (62 vs. 69%, P < .001) or PAD intervention (61 vs. 67%, P < .001) and also less likely to be discharged on an antiplatelet and statin regimen after these procedures (AAA: 60% vs. 64%, P = .01; PAD: 64% vs. 67%, P < .001). Black patients presented with more severe disease, including higher proportions of symptomatic carotid disease (36 vs. 31%, P < .001), symptomatic/ruptured AAA (27 vs. 16%, P < .001), and chronic limb-threatening ischemia (73 vs. 62%, P < .001). Black patients more often presented with concurrent iliac artery aneurysms at the time of AAA repair (elective open AAA repair: 46% vs. 26%, P < .001; elective EVAR: 38% vs. 23%, P < .001). Black patients present with more advanced disease at the time of initial major vascular operation. Efforts to control risk factors, identify and treat arterial disease in a timely fashion, and optimize medical management among black patients may provide opportunity to improve current disparities.
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影响因子：
--
作者：
Corbie-Smith, G;Thomas, SB;St George, DMM
通讯作者：
St George, DMM
影响因子：
8.3
作者：
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158.5
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通讯作者：
Ko, Clifford Y.