Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
Am J Cardiol. 2022 Jul 15;175:26-37. doi: 10.1016/j.amjcard.2022.03.056. Epub 2022 May 14.
Complex High-risk but indicated Percutaneous coronary interventions (CHiPs) is increasingly common in contemporary practice. However, data on ethnic differences in CHiP types, outcomes, and trends in patients with stable angina are limited; this is pertinent given the population of Black, Asian, and other ethnic minorities (BAME) in Europe is increasing. We conducted a retrospective analysis of CHiP procedures undertaken in patients with stable angina using data obtained from the BCIS (British Cardiovascular Intervention Society) registry (2006 to 2017). CHiP cases were identified and categorized by ethnicity into White and BAME groups. We then performed multivariable regression analysis and propensity score matching to determine adjusted odds ratios (aORs) of in-hospital mortality, major bleeding, and major adverse cardiovascular and cerebral events (MACCEs) in BAME compared with Whites. Of 424,290 procedure records, 105,949 were CHiP (25.0%) (White 89,038 [84%], BAME 16,911 [16%]). BAME patients were younger (median 68.1 vs 70.6 years). Previous coronary artery bypass surgery (33.4% vs 38.3%), followed by chronic total occlusion percutaneous coronary intervention (31.9% vs 32%) were common CHiP variables in both groups. The third common variable was age 80 years and above (23.6%) in White patients and severe vascular calcifications in BAME patients (18.8%). BAME patients had higher rates of diabetes (41.1 vs 23.6%), hypertension (68 vs 66.5%), previous percutaneous coronary intervention (43.7 vs 37.6%), and previous myocardial infarction (44.9 vs 42.5%), (p <0.001 for all). Mortality (aOR 1.1, 95% confidence interval [CI] 0.8 to 1.5) and MACCE (aOR 1.0, 95% CI 0.8 to 1.1) odds were similar among the groups. Bleeding odds (aOR 0.7, 95% CI 0.6 to 0.9) were lower in BAME. In conclusion, CHiP procedures differed among the ethnic groups. BAME patients were younger and had worse cardiometabolic profiles. Similar odds of death and MACCE were seen in BAME compared with their White counterparts. Bleeding odds were 30% lower in the BAME group.
复杂高危但适应证明确的经皮冠状动脉介入治疗（CHiPs）在当代实践中越来越常见。然而，关于稳定型心绞痛患者的 CHiP 类型、结局和趋势的种族差异的数据有限；鉴于欧洲的黑人、亚洲人和其他少数族裔（BAME）人口不断增加，这一点尤为重要。我们使用从英国心血管介入学会（BCIS）登记处（2006 年至 2017 年）获得的数据，对接受稳定型心绞痛的 CHiP 患者进行了回顾性分析。CHiP 病例按种族分为白人组和 BAME 组。然后，我们进行多变量回归分析和倾向评分匹配，以确定与白人相比，BAME 患者住院死亡率、大出血和主要不良心血管和脑事件（MACCEs）的调整比值比（aOR）。在 424290 例手术记录中，有 105949 例是 CHiP（25.0%）（白人 89038[84%]，BAME 16911[16%]）。BAME 患者年龄较小（中位数 68.1 岁 vs 70.6 岁）。两组中常见的 CHiP 变量是既往冠状动脉旁路移植术（33.4% vs 38.3%）和慢性完全闭塞经皮冠状动脉介入治疗（31.9% vs 32%）。第三个常见变量是白人患者年龄 80 岁及以上（23.6%）和 BAME 患者严重血管钙化（18.8%）。BAME 患者糖尿病（41.1% vs 23.6%）、高血压（68% vs 66.5%）、既往经皮冠状动脉介入治疗（43.7% vs 37.6%）和既往心肌梗死（44.9% vs 42.5%）的发生率较高（均<0.001）。死亡率（aOR 1.1，95%置信区间 [CI] 0.8 至 1.5）和 MACCE（aOR 1.0，95% CI 0.8 至 1.1）的几率在两组间相似。BAME 患者的出血几率（aOR 0.7，95% CI 0.6 至 0.9）较低。总之，CHiP 手术在不同种族间存在差异。BAME 患者年龄较小，合并症代谢指标较差。与白人相比，BAME 患者的死亡和 MACCE 几率相似。BAME 组出血几率低 30%。
