Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY.
Division of General Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.
J Vasc Surg. 2023 Jul;78(1):175-183.e3. doi: 10.1016/j.jvs.2023.02.015. Epub 2023 Mar 6.
The nature of peripheral arterial disease and postoperative outcomes are understudied in Asian patients. We aimed to determine if there are disparities in disease severity at the time of presentation and postoperative outcomes with regard to Asian race.
We analyzed the Society for Vascular Surgery Vascular Quality Initiative Peripheral Vascular Intervention dataset from 2017 to 2021, which includes endovascular lower extremity interventions. Propensity scores were used to match White and Asian patients based on age, sex, comorbidities, ambulatory/functional status, and intervention level. Differences were examined with regard to Asian race across all patients in the United States, Canada, and Singapore, and separately in the United States and Canada only. The primary outcome was emergent intervention. We also examined differences in severity of disease and postoperative outcomes.
A total of 80,312 White and 1689 Asian patients underwent peripheral vascular intervention. After propensity score matching, we identified 1669 matched pairs of patients across all centers including Singapore and 1072 matched pairs in the United States and Canada only. Among the matched cohort consisting of all centers, Asian patients had a higher rate of emergent intervention to prevent limb loss (5.6% vs 1.7%, P < .001). The majority of Asian patients presented with chronic limb threatening ischemia at a higher rate than White patients within the cohort including Singapore (71% vs 66%, P = .005). Within both propensity-matched cohorts, the rate of in-hospital death was higher in Asian patients (all centers: 3.1% vs 1.2%, P < .001; United States and Canada only: 2.1% vs 0.8%, P = .010). Logistic regression demonstrated greater odds of emergent intervention in Asian patients from all centers including Singapore (odds ratio [OR], 3.3; 95% confidence interval [CI], 2.2-5.1, P < .001) but not in the United States and Canada only (OR, 1.4; 95% CI, 0.8-2.8, P = .261). In addition, Asian patients had greater odds of in-hospital death in both matched cohorts (all centers: OR, 2.6; 95% CI, 1.5-4.4, P < .001; United States and Canada: OR, 2.5; 95% CI, 1.1-5.8, P = .026). Asian race was associated with a greater risk of loss of primary patency at 18 months (all centers: hazard ratio, 1.5; CI, 1.2-1.8, P = .001; United States and Canada only: hazard ratio, 1.5; CI, 1.2-1.9, P = .002).
Asian patients are more likely to present with advanced peripheral arterial disease and undergo emergent intervention to prevent limb loss, in addition to having worse postoperative outcomes and long-term patency. These results highlight the need for improved screening and postoperative follow-up in this understudied population.
外周动脉疾病的性质和术后结果在亚洲患者中研究较少。我们旨在确定亚洲人种在发病时的疾病严重程度和术后结果是否存在差异。
我们分析了 2017 年至 2021 年期间血管外科学会血管质量倡议外周血管介入数据集，其中包括下肢血管腔内介入治疗。采用倾向评分法根据年龄、性别、合并症、活动/功能状态和干预水平，将白人患者和亚洲患者进行匹配。在美国、加拿大和新加坡所有患者中以及仅在美国和加拿大患者中，检查了亚洲人种之间的差异。主要结局为紧急干预。我们还检查了疾病严重程度和术后结果的差异。
共有 80312 名白人患者和 1689 名亚洲患者接受了外周血管介入治疗。在进行倾向评分匹配后，我们在包括新加坡在内的所有中心识别出了 1669 对匹配患者，在美国和加拿大仅匹配出了 1072 对。在包括新加坡在内的所有中心的匹配队列中，亚洲患者需要紧急干预以防止肢体丧失的发生率更高（5.6%比 1.7%，P<.001）。在包括新加坡在内的队列中，大多数亚洲患者表现出更高的慢性肢体缺血威胁发病率，高于白人患者（71%比 66%，P=.005）。在两个倾向评分匹配队列中，亚洲患者的院内死亡率均较高（所有中心：3.1%比 1.2%，P<.001；美国和加拿大：2.1%比 0.8%，P=.010）。Logistic 回归分析显示，包括新加坡在内的所有中心的亚洲患者紧急干预的可能性更大（比值比[OR]，3.3；95%置信区间[CI]，2.2-5.1，P<.001），但在美国和加拿大仅为（OR，1.4；95%CI，0.8-2.8，P=261）。此外，在两个匹配队列中，亚洲患者的院内死亡风险均较高（所有中心：OR，2.6；95%CI，1.5-4.4，P<.001；美国和加拿大：OR，2.5；95%CI，1.1-5.8，P=26）。亚洲人种与 18 个月时原发性通畅率丧失的风险增加相关（所有中心：风险比，1.5；CI，1.2-1.8，P=0.001；美国和加拿大仅：风险比，1.5；CI，1.2-1.9，P=0.002）。
与白人患者相比，亚洲患者更有可能出现晚期外周动脉疾病，需要紧急干预以防止肢体丧失，此外，他们的术后结果和长期通畅率更差。这些结果强调了在这一研究较少的人群中需要改进筛查和术后随访。
