Divisions of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California.
Divisions of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California.
Am J Cardiol. 2023 Oct 15;205:120-125. doi: 10.1016/j.amjcard.2023.07.169. Epub 2023 Aug 17.
Asian American/Pacific Islanders (AAPIs) and Hispanics are growing minority United States populations, but are poorly represented in the cardiovascular literature. This study examines guideline adherence and outcomes in AAPIs and Hispanics compared with non-Hispanic Whites (NHWs) in a quaternary care center after inpatient percutaneous coronary intervention (PCI). The primary end points were inpatient post-PCI bleed, heart failure, cardiogenic shock, and all-cause mortality, whereas the secondary end point was the prescription rate of post-PCI guideline-directed medical therapy including aspirin, statins, P2Y receptor blockers, and cardiopulmonary rehabilitation. Intergroup differences were assessed through analysis of variance or two-way chi-square tests, and the association of race with binary outcomes was examined through logistic regression with NHW as the reference group. Compared with NHW, AAPIs, and Hispanics had higher odds of diabetes mellitus, and AAPIs had higher odds of hypertension and being on dialysis. Hispanics had higher odds of post-PCI mortality versus NHW, both in acute coronary syndrome (odds ratio [OR] 2.04, p = 0.03) and elective PCI (OR 2.51, p = 0.04). AAPI also trended toward higher mortality than NHW in both categories. AAPIs were found to have higher odds of statin prescription (OR 1.91, p = 0.04). Hispanics had lower odds of ticagrelor prescription versus NHW (OR 0.65, p = 0.04), and AAPIs trended toward such. No differences were found for cardiopulmonary rehabilitation prescriptions in groups. This study suggests that despite quality improvement efforts, disparities remain in postprocedural outcomes in minority groups in comparison with NHW.
亚裔美国人/太平洋岛民（AAPIs）和西班牙裔是美国不断增长的少数族裔群体，但在心血管文献中代表性不足。本研究在一家四级保健中心，在住院经皮冠状动脉介入治疗（PCI）后，比较了 AAPIs 和西班牙裔与非西班牙裔白人（NHW）之间的指南遵循情况和结局。主要终点为住院期间 PCI 后出血、心力衰竭、心源性休克和全因死亡率，次要终点为 PCI 后指南导向的药物治疗（包括阿司匹林、他汀类药物、P2Y 受体阻滞剂和心肺康复）的处方率。通过方差分析或双向卡方检验评估组间差异，并通过逻辑回归以 NHW 为参照组，评估种族与二分类结局的相关性。与 NHW 相比，AAPIs 和西班牙裔的糖尿病患病率更高，AAPIs 的高血压患病率和透析患病率更高。与 NHW 相比，西班牙裔在急性冠状动脉综合征（OR 2.04，p=0.03）和择期 PCI（OR 2.51，p=0.04）中 PCI 后死亡率更高。AAPI 在这两个类别中也比 NHW 有更高的死亡趋势。发现 AAPI 开具他汀类药物的几率更高（OR 1.91，p=0.04）。与 NHW 相比，西班牙裔开具替格瑞洛的几率较低（OR 0.65，p=0.04），AAPI 也有这种趋势。各组心肺康复处方无差异。本研究表明，尽管进行了质量改进努力，但与 NHW 相比，少数民族群体在术后结局方面仍存在差异。
