种族与无症状性颈动脉狭窄颈动脉内膜切除术围手术期结局的关系：NSQIP 研究。
Association between Race and Perioperative Outcomes after Carotid Endarterectomy for Asymptomatic Carotid Artery Stenosis in NSQIP.
机构信息
From the Division of Vascular Surgery and Endovascular Therapy (Mallela, Abularrage, Hicks), Johns Hopkins University School of Medicine, Baltimore, MD.
the Department of Surgery, Yale University School of Medicine, New Haven, CT (Canner).
出版信息
J Am Coll Surg. 2022 Jan 1;234(1):65-73. doi: 10.1097/XCS.0000000000000016.
BACKGROUND
Previous studies have documented that Black patients have worse outcomes after lower extremity revascularization procedures compared with White patients. However, the association of race on carotid endarterectomy (CEA) outcomes is not well described. The aim of this study was to compare perioperative outcomes of CEA for Black vs White patients with asymptomatic carotid artery stenosis.
STUDY DESIGN
All patients who underwent CEA for asymptomatic carotid stenosis in the ACS-NSQIP targeted vascular database (2011-2019) were included. Perioperative (30-day) outcomes were compared for Black vs White patients using multivariable logistic regression adjusting for age/sex, comorbidities, and disease characteristics.
RESULTS
Of 16,764 asymptomatic CEA patients, 95.2% (N = 15,960) were White and 4.8% (N = 804) were Black. Black patients were slightly younger (mean age 71.4 ± 0.1 vs 69.9 ± 0.3 years, P < 0.001) and more frequently had high-grade carotid artery stenosis compared to White patients (79.5% vs 74.0%, p = 0.001). Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients (p ≤ 0.01). Crude perioperative stroke (2.4% vs 1.3%, p = 0.007) and stroke/death (2.6% vs 1.4%, p = 0.003) were higher for Black patients, but myocardial infarction (1.7% vs 1.5%, p = 0.67) and death (0.4% vs 0.2%, p = 0.12) were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke (odds ratio 1.66, 95% CI 1.01 to 2.73) and stroke/death (odds ratio 1.75, 95% CI 1.10 to 2.81) remained significantly higher for Black patients compared with White patients.
CONCLUSIONS
Black patients undergoing CEA for asymptomatic carotid artery stenosis had more severe stenosis, more comorbidities, and worse perioperative outcomes compared to White patients. Overall, our data suggest substantial differences in the treatment and outcomes of asymptomatic carotid artery stenosis based on race.
背景
先前的研究表明，与白人患者相比，黑人患者下肢血运重建术后的预后更差。然而，种族对颈动脉内膜切除术（CEA）结果的影响尚不清楚。本研究旨在比较无症状颈动脉狭窄患者中黑人与白人行 CEA 的围手术期结果。
研究设计
所有在 ACS-NSQIP 靶向血管数据库（2011-2019 年）中接受无症状颈动脉狭窄 CEA 的患者均纳入研究。使用多变量逻辑回归对黑人与白人患者进行调整，以比较围手术期（30 天）结果，调整因素包括年龄/性别、合并症和疾病特征。
结果
在 16764 例无症状 CEA 患者中，95.2%（N=15960）为白人，4.8%（N=804）为黑人。黑人患者的年龄稍小（平均年龄 71.4±0.1 岁 vs. 69.9±0.3 岁，P<0.001），颈动脉狭窄程度更高（79.5% vs. 74.0%，p=0.001）。黑人患者更常患有高血压、糖尿病、肾脏疾病、充血性心力衰竭和冠状动脉疾病（p≤0.01）。黑人患者的围手术期卒中（2.4% vs. 1.3%，p=0.007）和卒中/死亡（2.6% vs. 1.4%，p=0.003）发生率更高，但心肌梗死（1.7% vs. 1.5%，p=0.67）和死亡（0.4% vs. 0.2%，p=0.12）发生率相似。调整组间基线差异后，黑人患者的围手术期卒中风险（比值比 1.66，95%CI 1.01-2.73）和卒中/死亡风险（比值比 1.75，95%CI 1.10-2.81）仍显著高于白人患者。
结论
与白人患者相比，行 CEA 治疗无症状颈动脉狭窄的黑人患者狭窄程度更严重，合并症更多，围手术期结局更差。总体而言，我们的数据表明，种族是无症状颈动脉狭窄治疗和结局的一个重要决定因素。
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