Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Sahlgrenska University Hospital, Gothenburg, Sweden.
JACC Cardiovasc Interv. 2020 Jul 13;13(13):1586-1595. doi: 10.1016/j.jcin.2020.04.020.
The aim of this study was to assess race-based differences in patients undergoing percutaneous coronary intervention from a large pooled database of randomized controlled trials.
Data on race-based outcomes after percutaneous coronary intervention are limited, deriving mainly from registries and single-center studies.
Baseline characteristics and outcomes at 30 days, 1 year, and 5 years were assessed across different races, from an individual patient data pooled analysis from 10 randomized trials. Endpoints of interest included death, myocardial infarction, and major adverse cardiac events (defined as cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization). Multivariate Cox proportional hazards regression was performed to assess associations between race and outcomes, controlling for differences in 12 baseline covariates.
Among 22,638 patients, 20,585 (90.9%) were white, 918 (4.1%) were black, 404 (1.8%) were Asian, and 473 (2.1%) were Hispanic. Baseline and angiographic characteristics differed among groups. Five-year major adverse cardiac event rates were 18.8% in white patients (reference group), compared with 23.9% in black patients (p = 0.0009), 11.2% in Asian patients (p = 0.0007), and 21.5% in Hispanic patients (p = 0.07). Multivariate analysis demonstrated an independent association between black race and 5-year risk for major adverse cardiac events (hazard ratio: 1.28; 95% confidence interval: 1.05 to 1.57; p = 0.01).
In the present large-scale individual patient data pooled analysis, comorbidities were significantly more frequent in minority-group patients than in white patients enrolled in coronary stent randomized controlled trials. After accounting for these differences, black race was an independent predictor of worse outcomes, whereas Hispanic ethnicity and Asian race were not. Further research examining race-based outcomes after percutaneous coronary intervention is warranted to understand these differences.
本研究旨在评估大型随机对照试验汇总数据库中接受经皮冠状动脉介入治疗的患者的种族差异。
经皮冠状动脉介入治疗后基于种族的结局数据有限，主要来源于注册研究和单中心研究。
从 10 项随机试验的个体患者数据汇总分析中评估不同种族的基线特征和 30 天、1 年和 5 年的结局。研究终点包括死亡、心肌梗死和主要不良心脏事件（定义为心脏死亡、心肌梗死或缺血驱动的靶病变血运重建）。采用多变量 Cox 比例风险回归评估种族与结局之间的关联，同时控制 12 项基线协变量的差异。
在 22638 例患者中，20585 例（90.9%）为白人，918 例（4.1%）为黑人，404 例（1.8%）为亚洲人，473 例（2.1%）为西班牙裔。各组间的基线和血管造影特征存在差异。白人患者 5 年主要不良心脏事件发生率为 18.8%（参照组），黑人患者为 23.9%（p=0.0009），亚洲人为 11.2%（p=0.0007），西班牙裔人为 21.5%（p=0.07）。多变量分析显示，黑种人种族与 5 年主要不良心脏事件风险之间存在独立关联（风险比：1.28；95%置信区间：1.05 至 1.57；p=0.01）。
在本次大规模的个体患者数据汇总分析中，与接受冠状动脉支架置入随机对照试验的白人患者相比，少数民族患者的合并症更为常见。在考虑到这些差异后，黑种人种族是预后较差的独立预测因素，而西班牙裔和亚洲种族则不是。需要进一步研究经皮冠状动脉介入治疗后基于种族的结局，以了解这些差异。
