Elbadawi Ayman, Mahmoud Karim, Elgendy Islam Y, Elzeneini Mohammed, Megaly Michael, Ogunbayo Gbolahan, Omer Mohamed A, Albert Michelle, Kapadia Samir, Jneid Hani
Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, United States of America.
Department of Internal Medicine, Houston Medical Center, Warner Robins, GA, United States of America.
Cardiovasc Revasc Med. 2020 Nov;21(11):1425-1430. doi: 10.1016/j.carrev.2020.04.034. Epub 2020 Apr 30.
There is paucity of data on racial disparities in the utilization and outcomes of transcatheter mitral valve repair (TMVR).
We queried the National inpatient Sample database (2012-2016) for TMVR hospitalizations among Caucasian and African American patients. We conducted a propensity score matching analysis to compare outcomes of Caucasians versus African Americans. The main study outcome was in-hospital mortality.
Among 7940 TMVR procedures performed, 680 (8.6%) were performed in African Americans. TMVR was increasingly performed for both Caucasians and African Americans (P = 0.01), although the proportion of African Americans did not change significantly over time (P = 0.45). Compared to African Americans, Caucasians undergoing TMVR were significantly older (77.7 ± 10.8 vs. 67.2 ± 14.28, p < .001) and less likely to be women (45.3% vs.60.3%, p < .001). Caucasians undergoing TMVR had a higher in-hospital mortality compared with African Americans before matching (2.5% vs. 1.5%, odds ratio [OR] 1.75; 95% confidence interval [CI] 1.17:2.63, p = .01) as well as after matching (4.7% vs. 1.6%, OR 3.10; 95% CI 1.61:5.97, p < .001). Caucasians had higher in-hospital cardiac arrest and pacemaker insertion and shorter median length of stay. There was no difference in the incidence of other in-hospital outcomes between Caucasians and African Americans.
This nationwide observational analysis showed a steady increase in number of TMVRs among Caucasians and African Americans. TMVR was performed in a select cohort of African Americans who were significantly younger and more likely to be women compared with Caucasians. Caucasians undergoing TMVR had higher in-hospital mortality compared with African Americans. Further research is needed to explore the reasons behind the racial disparities in the utilization and outcomes of TMVR.
关于经导管二尖瓣修复术（TMVR）的使用情况及治疗结果方面的种族差异，相关数据较少。
我们查询了国家住院患者样本数据库（2012 - 2016年）中白种人和非裔美国患者的TMVR住院病例。我们进行了倾向评分匹配分析，以比较白种人和非裔美国人的治疗结果。主要研究结果是住院死亡率。
在7940例TMVR手术中，680例（8.6%）是为非裔美国人实施的。白种人和非裔美国人接受TMVR手术的比例均呈上升趋势（P = 0.01），不过非裔美国人的比例随时间变化无显著差异（P = 0.45）。与非裔美国人相比，接受TMVR手术的白种人年龄显著更大（77.7 ± 10.8岁 vs. 67.2 ± 14.28岁，p <.001），且女性比例更低（45.3% vs. 60.3%，p <.001）。在匹配前，接受TMVR手术的白种人的住院死亡率高于非裔美国人（2.5% vs. 1.5%，比值比[OR] 1.75；95%置信区间[CI] 1.17:2.63，p = 0.01），匹配后同样如此（4.7% vs. 1.6%，OR 3.10；95% CI 1.61:5.97，p <.001）。白种人的院内心脏骤停和起搏器植入发生率更高，住院中位时长更短。白种人和非裔美国人在其他院内治疗结果的发生率上无差异。
这项全国性观察性分析表明，白种人和非裔美国人中TMVR手术数量稳步增加。TMVR手术主要针对特定的非裔美国人队列，他们与白种人相比年龄显著更小，且女性比例更高。接受TMVR手术的白种人的住院死亡率高于非裔美国人。需要进一步研究以探究TMVR使用情况及治疗结果方面种族差异背后的原因。
