The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., J.C.).
Box Hill Hospital, Monash University, Melbourne, Australia (J.C.).
Circ Cardiovasc Interv. 2019 Apr;12(4):e006918. doi: 10.1161/CIRCINTERVENTIONS.118.006918.
Background The impact of race/ethnicity on coronary stent outcomes in women is unknown. We compared baseline characteristics, social determinants of health, and 1-year outcomes in female African Americans (AA) and Hispanic/Latinas (HL) versus white women after coronary everolimus-eluting stent implantation in all-comer patients. Methods and Results We pooled 1863 women from the PLATINUM Diversity (n=1057 women) and PROMUS ELEMENT PLUS (n=806 women) postapproval studies, with some overlap in study sites. Social determinants of health data were only available for PLATINUM Diversity. The primary end point was 1-year major adverse cardiac events (death, myocardial infarction, or target vessel revascularization). Outcomes were risk adjusted using multivariate Cox regression. The study sample comprised 1417 white (76.1%, reference group), 296 AA (15.9%), and 107 HL (5.7%) women. AA were older, and both AA and HL had more diabetes mellitus and hypertension than white women. AA had larger reference vessel diameters but less lesion calcification, whereas HL had less lesion tortuosity but more calcification. Compared with white women, there was a trend toward higher unadjusted 1-year major adverse cardiac events in AA (12.0% versus 8.0%; P=0.06) but similar rates in HL (11.0% versus 8.0%; P=0.32), and after risk adjustment, there were no differences (AA women: hazard ratio, 1.47; 95% CI, 1.00-2.17; HL women: hazard ratio, 1.33; 95% CI, 0.71-2.44). AA had a 3-fold higher adjusted risk of 1-year myocardial infarction (hazard ratio, 3.45; 95% CI, 1.72-7.14; P=0.01) and increased risk of target vessel revascularization (hazard ratio, 1.82; 95% CI, 1.10-2.94; P=0.02). Independent predictors of major adverse cardiac events included renal disease, prior myocardial infarction, silent ischemia, history of stroke, and multivessel disease. Conclusions Race and ethnicity confer heterogeneity in women undergoing everolimus-eluting stent implantation. Despite more comorbidities and less favorable social determinants of health, AA and HL women have similar 1-year major adverse cardiac events to white women, although AA women seem to have a higher risk of 1-year myocardial infarction. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02240810.
种族/民族对女性冠状动脉支架治疗结局的影响尚不清楚。我们比较了在所有患者中接受依维莫司洗脱支架植入后，非裔美国女性（AA）和西班牙裔/拉丁裔（HL）与白人女性的基线特征、健康社会决定因素和 1 年结局。
我们汇总了来自 PLATINUM Diversity（n=1057 名女性）和 PROMUS ELEMENT PLUS（n=806 名女性）两项上市后研究的 1863 名女性，这些研究在研究地点上存在部分重叠。仅 PLATINUM Diversity 研究提供了健康社会决定因素数据。主要终点为 1 年主要不良心脏事件（死亡、心肌梗死或靶血管血运重建）。使用多变量 Cox 回归进行风险调整。研究样本包括 1417 名白人（76.1%，参考组）、296 名 AA（15.9%）和 107 名 HL（5.7%）女性。AA 年龄较大，AA 和 HL 均有更多的糖尿病和高血压。AA 的参考血管直径较大，但病变钙化较少，而 HL 的病变迂曲程度较小，但钙化较多。与白人女性相比，AA 女性的未经调整的 1 年主要不良心脏事件有升高趋势（12.0%比 8.0%；P=0.06），但 HL 女性相似（11.0%比 8.0%；P=0.32），调整风险后无差异（AA 女性：风险比，1.47；95%CI，1.00-2.17；HL 女性：风险比，1.33；95%CI，0.71-2.44）。AA 女性 1 年心肌梗死的调整风险高 3 倍（风险比，3.45；95%CI，1.72-7.14；P=0.01），靶血管血运重建的风险增加（风险比，1.82；95%CI，1.10-2.94；P=0.02）。主要不良心脏事件的独立预测因素包括肾脏疾病、既往心肌梗死、无症状性缺血、中风史和多血管疾病。
种族和民族在接受依维莫司洗脱支架植入的女性中存在异质性。尽管 AA 和 HL 女性有更多的合并症和较差的健康社会决定因素，但她们与白人女性的 1 年主要不良心脏事件相似，尽管 AA 女性的 1 年心肌梗死风险似乎更高。
