种族/民族和性别对糖尿病患者冠状动脉支架置入术预后的影响

Influence of Race/Ethnicity and Sex on Coronary Stent Outcomes in Diabetic Patients.

作者信息

Epps Kelly, Goel Ridhima, Mehran Roxana, Kandzari David, Damluji Abdulla, Tehrani Behnam, Sherwood Matthew, Truesdell Alexander, Davis Scott, Wang John C, Lopez Mario, Singh Sarabjeet, Underwood Paul, Allocco Dominic, Batchelor Wayne

机构信息

Inova Heart and Vascular Institute, Falls Church, Virginia.

Mount Sinai Medical Center, New York, New York.

出版信息

J Soc Cardiovasc Angiogr Interv. 2023 Sep-Oct;2(5). doi: 10.1016/j.jscai.2023.101053. Epub 2023 Aug 4.

BACKGROUND

How diabetes mellitus (DM), race/ethnicity, and sex impact ischemic events following coronary artery stent procedures is unknown.

METHODS

Using the PLATINUM Diversity and PROMUS Element Plus Post-Approval Pooled Study (N = 4184), we examined the impact of race/ethnicity, sex, and DM on coronary stent outcomes. Primary outcome was 1-year major adverse cardiac events (MACE) (MACE composite: death, myocardial infarction [MI], and target vessel revascularization).

RESULTS

The study sample included 1437 diabetic patients (501 White men, 470 White women, 246 minority men, 220 minority women) and 2641 patients without medically treated DM (561 minority, 1090 women). Mean age (years) ranged from 61 in minority men to 65 in White women. Diabetic patients had a higher prevalence of atherosclerotic risk factors and comorbidities. Diabetic minority women (DMW; 70% Black, 27% Hispanic) had similar atherosclerotic risk factors to other diabetics, but experienced higher 1-year MACE (14.4% vs 7.5%, <.01) and MI (4.3% vs 1.6%, <.01) rates compared with patients without medically treated DM. No other diabetic cohort (White men, White women, minority men) showed an increased risk of MACE vs patients without medically treated DM. The incremental risk of MACE in DMW was associated with insulin use and persisted after risk adjustment (adjusted odds ratio 1.6 vs patients without medically treated DM; 95% CI, 1.0-2.5). Independent predictors of 1-year MACE included insulin use, hyperlipidemia, renal disease, and prior MI.

CONCLUSIONS

DMW face the highest risk of ischemic events following coronary stenting, driven, in part, by insulin use. Aggressive secondary prevention and strict glycemic control are imperative in this cohort, and further research is warranted to elucidate the biologic mechanisms underpinning these observations.

CLINICAL TRIAL REGISTRATION

NCT02240810 (http://clinicaltrials.gov/).

背景

糖尿病（DM）、种族/民族和性别如何影响冠状动脉支架置入术后的缺血性事件尚不清楚。

方法

利用铂类药物多样性和PROMUS Element Plus批准后汇总研究（N = 4184），我们研究了种族/民族、性别和糖尿病对冠状动脉支架置入术后结果的影响。主要结局是1年主要不良心脏事件（MACE）（MACE综合指标：死亡、心肌梗死[MI]和靶血管血运重建）。

结果

研究样本包括1437例糖尿病患者（501例白人男性、470例白人女性、246例少数族裔男性、220例少数族裔女性）和2641例未经药物治疗的糖尿病患者（561例少数族裔、1090例女性）。平均年龄（岁）范围从少数族裔男性的61岁到白人女性的65岁。糖尿病患者动脉粥样硬化危险因素和合并症的患病率更高。糖尿病少数族裔女性（DMW；70%为黑人，27%为西班牙裔）与其他糖尿病患者有相似的动脉粥样硬化危险因素，但与未经药物治疗的糖尿病患者相比，其1年MACE发生率（14.4%对7.5%，P <.01）和MI发生率（4.3%对1.6%，P <.01）更高。没有其他糖尿病队列（白人男性、白人女性、少数族裔男性）显示与未经药物治疗的糖尿病患者相比MACE风险增加。DMW中MACE的增量风险与胰岛素使用有关，且在风险调整后仍然存在（调整后的优势比为1.6，与未经药物治疗的糖尿病患者相比；95%可信区间，1.0 - 2.5）。1年MACE的独立预测因素包括胰岛素使用、高脂血症、肾病和既往MI。