Parikh Shailja V, Enriquez Jonathan R, Selzer Faith, Slater James N, Laskey Warren K, Wilensky Robert L, Marroquin Oscar C, Holper Elizabeth M
Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern, Dallas, Texas, USA.
Am J Cardiol. 2009 Sep 15;104(6):775-9. doi: 10.1016/j.amjcard.2009.05.006. Epub 2009 Jul 25.
Although previous studies have demonstrated that Hispanic patients have a higher cardiovascular risk profile than Caucasians and present at a younger age for percutaneous coronary intervention (PCI), limited studies exist examining the outcomes of Hispanics after PCI and potential explanations for differences noted. Using patients from the National Heart, Lung, and Blood Institute Dynamic Registry waves 1 to 5 (1997 to 2006), demographic features, angiographic data, and 1-year outcomes of Hispanic patients (n = 542) versus Caucasian patients (n = 1,357) undergoing PCI were evaluated. Compared to Caucasians, Hispanic patients were younger and had more hypertension and diabetes mellitus, including more insulin-treated diabetes mellitus. Although mean lesion length was longer in Hispanics (15.4 vs 14.1 mm, p <0.001), there were no differences in the number of significant lesions or in the use of drug-eluting stents. At follow-up, Hispanics were more likely to report recent anginal symptoms but had a similar incidence of 1-year hospitalizations for angina. Adjusted 1-year hazard ratios for adverse events for Hispanics versus Caucasians revealed lower rates of coronary artery bypass graft surgery (hazard ratio 0.43, confidence interval 0.22 to 0.85, p = 0.02) and a trend toward lower rates of repeat revascularization (hazard ratio 0.76, confidence interval 0.57 to 1.03, p = 0.08). In conclusion, despite the presence of diabetes in almost 50% of Hispanic patients and longer lesions than in Caucasians, Hispanic patients were less likely to undergo coronary artery bypass graft surgery 1 year after PCI and had a trend toward lower rates of repeat revascularization.
尽管先前的研究表明，西班牙裔患者的心血管疾病风险状况高于白种人，且进行经皮冠状动脉介入治疗（PCI）的年龄更小，但针对西班牙裔患者PCI术后的结局以及所观察到差异的潜在原因进行研究的却很有限。利用美国国立心肺血液研究所动态注册研究第1至5波（1997年至2006年）的患者，对接受PCI的西班牙裔患者（n = 542）与白种人患者（n = 1357）的人口统计学特征、血管造影数据及1年结局进行了评估。与白种人相比，西班牙裔患者更年轻，患有更多高血压和糖尿病，包括更多接受胰岛素治疗的糖尿病患者。尽管西班牙裔患者的平均病变长度更长（15.4 vs 14.1 mm，p <0.001），但在显著病变数量或药物洗脱支架的使用方面并无差异。随访时，西班牙裔患者更有可能报告近期心绞痛症状，但心绞痛1年住院发生率相似。西班牙裔患者与白种人患者不良事件的校正1年风险比显示，冠状动脉旁路移植术发生率较低（风险比0.43，置信区间0.22至0.85，p = 0.02），且重复血运重建率有降低趋势（风险比0.76，置信区间0.57至1.03，p = 0.08）。总之，尽管近50%的西班牙裔患者患有糖尿病且病变比白种人更长，但西班牙裔患者在PCI术后1年进行冠状动脉旁路移植术的可能性较小，且重复血运重建率有降低趋势。
