Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Card Surg. 2022 Aug;37(8):2317-2323. doi: 10.1111/jocs.16580. Epub 2022 May 5.
Thoracic endovascular aortic repair (TEVAR) became the standard of care for treating Type B aortic dissections and descending thoracic aortic aneurysms. We aimed to describe the racial/ethnic differences in TEVAR utilization and outcomes.
The National Inpatient Sample was reviewed for all TEVARs performed between 2010 and 2017 for Type B aortic dissection and descending thoracic aortic aneurysm (DTAA). We compared groups stratifying by their racial/ethnicity background in White, Black, Hispanic, and others. Mixed-effects logistic regression was performed to assess the relationship between race/ethnicity and the primary outcome, in-hospital mortality.
A total of 25,260 admissions for TEVAR during 2010-2017 were identified. Of those, 52.74% (n = 13,322) were performed for aneurysm and 47.2% (n = 11,938) were performed for Type B dissection. 68.1% were White, 19.6% were Black, 5.7% Hispanic, and 6.5% were classified as others. White patients were the oldest (median age 71 years; p < .001), with TEVAR being performed electively more often for aortic aneurysm (58.8% vs. 34% vs. 48.3% vs. 48.2%; p < .001). In contrast, TEVAR was more likely urgent or emergent for Type B dissection in Black patients (65.6% vs. 41.1% vs. 51.6% vs. 51.7%; p < .001). Finally, the Black population showed a relative increase in the incidence rate of TEVAR over time. The adjusted multivariable model showed that race/ethnicity was not associated with in-hospital mortality.
Although there is a differential distribution of thoracic indication and comorbidities between race/ethnicity in TEVAR, racial disparities do not appear to be associated with in-hospital mortality after adjusting for covariates.
胸主动脉腔内修复术（TEVAR）已成为治疗 B 型主动脉夹层和降主动脉夹层动脉瘤的标准治疗方法。我们旨在描述 TEVAR 利用和结果的种族/民族差异。
回顾了 2010 年至 2017 年期间因 B 型主动脉夹层和降主动脉夹层动脉瘤（DTAA）而行 TEVAR 的所有患者的国家住院患者样本。我们按其种族/民族背景将患者分为白人、黑人、西班牙裔和其他人群进行比较。混合效应逻辑回归用于评估种族/民族与主要结局（院内死亡率）之间的关系。
共确定了 2010 年至 2017 年期间 25260 例 TEVAR 入院患者。其中，52.74%（n=13322）为动脉瘤，47.2%（n=11938）为 B 型夹层。68.1%为白人，19.6%为黑人，5.7%为西班牙裔，6.5%为其他人群。白人患者年龄最大（中位数年龄 71 岁；p<.001），主动脉瘤行 TEVAR 更多为择期（58.8%比 34%比 48.3%比 48.2%；p<.001）。相反，黑人患者行 TEVAR 更多为紧急或紧急情况（65.6%比 41.1%比 51.6%比 51.7%；p<.001）。最后，黑人人群的 TEVAR 发生率随时间呈相对增加。调整后的多变量模型显示，种族/民族与院内死亡率无关。
尽管在 TEVAR 中种族/民族之间存在胸主动脉适应证和合并症的差异分布，但在调整协变量后，种族差异似乎与院内死亡率无关。
