种族差异对外周动脉介入治疗后的表现和结果的影响：来自 NCDR-PVI 注册研究的见解。
Racial Differences in Presentation and Outcomes After Peripheral Arterial Interventions: Insights From the NCDR-PVI Registry.
机构信息
Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.).
Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.).
出版信息
Circ Cardiovasc Interv. 2023 Jun;16(6):e011485. doi: 10.1161/CIRCINTERVENTIONS.121.011485. Epub 2023 Jun 20.
BACKGROUND
We assess the rates of device use and outcomes by race among patients undergoing lower extremity peripheral arterial intervention using the American College of Cardiology National Cardiovascular Data Registry-Peripheral Vascular Intervention (PVI) registry.
METHODS
Patients who underwent PVI between April 2014 and March 2019 were included. Socioeconomic status was evaluated using the Distressed Community Index score for patients' zip codes. Multivariable logistic regression was used to assess factors associated with utilization of drug-eluting technologies, intravascular imaging, and atherectomy. Among patients with Centers for Medicare and Medicaid Services data, we compared 1-year mortality, rates of amputation, and repeat revascularizations.
RESULTS
Of 63 150 study cases, 55 719 (88.2%) were performed in White patients and 7431 (11.8%) in Black patients. Black patients were younger (67.9 versus 70.0 years), had higher rates of hypertension (94.4% versus 89.5%), diabetes (63.0% versus 46.2%), less likely to be able to walk 200 m (29.1% versus 24.8%), and higher Distressed Community Index scores (65.1 versus 50.6). Black patients were provided drug-eluting technologies at a higher rate (adjusted odds ratio, 1.14 [95% CI, 1.06-1.23]) with no difference in atherectomy (adjusted odds ratio, 0.98 [95% CI, 0.91-1.05]) or intravascular imaging (adjusted odds ratio, 1.03 [95% CI, 0.88-1.22]) use. Black patients experienced a lower rate of acute kidney injury (adjusted odds ratio, 0.79 [95% CI, 0.72-0.88]). In Centers for Medicare and Medicaid Services-linked analyses of 7429 cases (11.8%), Black patients were significantly less likely to have surgical (adjusted hazard ratio, 0.40 [95% CI, 0.17-0.96]) or repeat PVI revascularization (adjusted hazard ratio, 0.42 [95% CI, 0.30-0.59]) at 1 year compared with White patients. There was no difference in mortality (adjusted hazard ratio [0.8-1.4]) or major amputation (adjusted hazard ratio, 2.5 [95% CI, 0.8-7.6]) between Black and White patients.
CONCLUSIONS
Black patients presenting for PVI were younger, had higher prevalence of comorbidities and lower socioeconomic status. After adjustment, Black patients were less likely to have surgical or repeat PVI revascularization after the index PVI procedure.
背景
我们评估了使用美国心脏病学会国家心血管数据注册中心-外周血管介入（PVI）登记处接受下肢外周动脉介入治疗的患者的种族与器械使用和结局的关系。
方法
纳入 2014 年 4 月至 2019 年 3 月期间接受 PVI 的患者。通过患者邮政编码的 Distressed Community Index 评分评估社会经济地位。采用多变量逻辑回归评估与药物洗脱技术、血管内成像和旋切术使用相关的因素。在有联邦医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services，CMS）数据的患者中，我们比较了 1 年死亡率、截肢率和再次血运重建率。
结果
在 63150 例研究病例中，55719 例（88.2%）为白人患者，7431 例（11.8%）为黑人患者。黑人患者更年轻（67.9 岁比 70.0 岁），高血压发生率更高（94.4%比 89.5%），糖尿病发生率更高（63.0%比 46.2%），能够行走 200 m 的可能性更小（29.1%比 24.8%），Distressed Community Index 评分更高（65.1 比 50.6）。黑人患者使用药物洗脱技术的比例更高（调整后优势比，1.14[95%CI，1.06-1.23]），旋切术（调整后优势比，0.98[95%CI，0.91-1.05]）和血管内成像（调整后优势比，1.03[95%CI，0.88-1.22]）的使用没有差异。黑人患者急性肾损伤发生率较低（调整后优势比，0.79[95%CI，0.72-0.88]）。在与 CMS 相关的 7429 例（11.8%）分析中，黑人患者与白人患者相比，1 年内接受手术（调整后风险比，0.40[95%CI，0.17-0.96]）或再次 PVI 血运重建（调整后风险比，0.42[95%CI，0.30-0.59]）的可能性显著较低。黑人患者的死亡率（调整后风险比[0.8-1.4]）或主要截肢率（调整后风险比，2.5[95%CI，0.8-7.6]）与白人患者无差异。
结论
接受 PVI 治疗的黑人患者更年轻，合并症患病率更高，社会经济地位更低。调整后，黑人患者在 PVI 指数治疗后接受手术或再次 PVI 血运重建的可能性较低。
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