London Health Sciences Centre, London, Ontario, Canada.
Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, Canada.
Int J Cardiol. 2021 Dec 1;344:73-81. doi: 10.1016/j.ijcard.2021.09.037. Epub 2021 Sep 21.
Transcatheter mitral edge-to-edge repair (TEER) is an increasingly common procedure performed on patients with severe mitral regurgitation. This study assessed the impact of race/ethnicity and socioeconomic status on in-hospital complications after TEER.
Cohort-based observational study using the National Inpatient Sample between October 2013 and December 2018. The population was stratified into 4 groups based on race/ethnicity and quartiles of neighborhood income levels. The primary outcome was in-hospital complications, defined as the composite of death, bleeding, cardiac and vascular complications, acute kidney injury, and ischemic stroke.
3795 hospitalizations for TEER were identified. Patients of Black and Hispanic race/ethnicity comprised 7.4% and 6.4%, respectively. We estimated that White patients received TEER with a frequency of 38.0/100,000, compared to 29.7/100,000 for Blacks and 30.5/100,000 for Hispanics. In-hospital complications occurred in 20.2% of patients and no differences were found between racial/ethnic groups (P = 0.06). After multilevel modelling, Black and Hispanic patients had similar rate of overall in-hospital complications (OR: 0.84, CI:0.67-1.05 and OR: 0.84, CI:0.66-1.07, respectively) as compared to White patients, however, higher rates of death were observed in Black patients. Individuals living in income quartile-1 had worse in-hospital outcomes as compared to quartile-4 (OR: 1.19, CI:0.99-1.42).
In this study assessing racial/ethnic disparities in TEER outcomes, aged-adjusted race/ethnicity minorities were less underrepresented as compared to other structural heart interventions. Black patients experienced a higher rate of in-hospital death, but similar overall rate of post-procedural adverse events as compared to White patients. Lower income levels appear to negatively impact on in-hospital outcomes.
This study appraises race/ethnic and socioeconomical disparities in access and outcomes following transcatheter mitral edge-to-edge repair. Racial minority groups were less underrepresented as compared to other structural heart interventions. While Black patients experienced a higher rate of in-hospital death, they experienced similar overall rate of post-procedural complications compared to White patients. Lower income levels also appeared to negatively impact on outcomes.
经导管二尖瓣缘对缘修复术（TEER）是一种越来越常见的治疗严重二尖瓣反流的方法。本研究评估了种族/民族和社会经济地位对 TEER 术后住院并发症的影响。
这是一项基于队列的观察性研究，使用了 2013 年 10 月至 2018 年 12 月期间的国家住院患者样本。人群根据种族/民族和社区收入水平的四分位数分为 4 组。主要结局是住院并发症，定义为死亡、出血、心脏和血管并发症、急性肾损伤和缺血性中风的综合指标。
共确定了 3795 例 TEER 住院治疗。黑人和西班牙裔患者分别占 7.4%和 6.4%。我们估计白人患者接受 TEER 的频率为 38.0/100,000，而黑人患者为 29.7/100,000，西班牙裔患者为 30.5/100,000。20.2%的患者发生住院并发症，不同种族/民族组之间无差异（P=0.06）。经过多水平模型分析，黑人和西班牙裔患者的总体住院并发症发生率与白人患者相似（OR：0.84，CI：0.67-1.05 和 OR：0.84，CI：0.66-1.07），但黑人患者的死亡率更高。与四分位 4 相比，居住在收入四分位 1 的个体的住院结局更差（OR：1.19，CI：0.99-1.42）。
在这项评估 TEER 结果中种族/民族差异的研究中，与其他结构性心脏干预措施相比，年龄调整后的种族/民族少数群体的代表性不足。黑人患者的住院死亡率更高，但与白人患者相比，总体术后不良事件发生率相似。较低的收入水平似乎对住院结果产生负面影响。
本研究评估了经导管二尖瓣缘对缘修复术后种族/民族和社会经济差异对治疗的影响。与其他结构性心脏干预措施相比，少数民族群体的代表性不足。黑人患者的住院死亡率较高，但与白人患者相比，总体术后并发症发生率相似。较低的收入水平似乎对结果产生负面影响。
