Patil Shivaraj, Rojulpote Chaitanya, Frick William, Bhattaru Abhijit, Sandhu Karanjit, Bakhshi Aditya, Shahzad Anum, Pressman Gregg, Chamoun Antonio, Verma Div, Lin Chien-Jung
Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States of America.
Department of Cardiology, St. Louis University, St. Louis, MO, United States of America.
Am Heart J Plus. 2024 May 20;43:100405. doi: 10.1016/j.ahjo.2024.100405. eCollection 2024 Jul.
Coronary in-stent restenosis (ISR) is a major clinical challenge of contemporary percutaneous revascularization and portends adverse cardiovascular outcomes.
We aimed to evaluate gender, race, and ethnicity related outcomes in acute coronary syndromes (ACS) with ISR.
Primary hospitalizations for ACS and ISR in the National Inpatient Sample database from 2016 to 2019 were included. Patients were stratified by gender, race, and ethnicity. The primary end points were all cause in-hospital mortality and coronary revascularization defined as composite of percutaneous coronary intervention (PCI), balloon angioplasty and/or coronary artery bypass grafting (CABG).
During the study period, a nationally weighted total of 97,680 patients with ACS and ISR were included. There was substantial variation in comorbidities, with greatest burden among Black and Hispanic women. All-cause in-hospital mortality was 2.4 % in the study cohort, but significantly higher in women (2.1 % vs. 2.1 %; aOR: 1.282, 95 % CI: 1.174-1.4; < 0.001) and revascularization rates were significantly lower in women (77 % vs 80.2 %; aOR: 0.891, 95 % CI: 0.862-0.921; p < 0.001). Compared to White men, all women except Hispanic women, had significantly higher likelihood of in-hospital mortality, while White women, Black men and women, and Hispanic men had lower odds of revascularization.
There are significant gender, racial, and ethnic related differences in revascularization practices and clinical outcomes in patients with ACS and ISR with an adverse impact on women, racial and ethnic minorities in the U.S.
冠状动脉支架内再狭窄（ISR）是当代经皮血管重建术面临的一项重大临床挑战，并预示着不良心血管结局。
我们旨在评估急性冠状动脉综合征（ACS）合并ISR患者中与性别、种族和族裔相关的结局。
纳入2016年至2019年国家住院样本数据库中因ACS和ISR而住院的患者。患者按性别、种族和族裔进行分层。主要终点为全因住院死亡率和定义为经皮冠状动脉介入治疗（PCI）、球囊血管成形术和/或冠状动脉旁路移植术（CABG）综合的冠状动脉血运重建。
在研究期间，全国加权共纳入97,680例ACS合并ISR患者。合并症存在显著差异，黑人女性和西班牙裔女性的负担最重。研究队列中的全因住院死亡率为2.4%，但女性显著更高（2.1%对2.1%；调整后比值比：1.282，95%置信区间：1.174 - 1.4；P < 0.001），且女性的血运重建率显著更低（77%对80.2%；调整后比值比：0.891，95%置信区间：0.862 - 0.921；P < 0.001）。与白人男性相比，除西班牙裔女性外的所有女性住院死亡率显著更高，而白人女性、黑人男性和女性以及西班牙裔男性血运重建的几率更低。
在美国，ACS合并ISR患者的血运重建操作和临床结局存在显著的性别、种族和族裔差异，对女性、少数种族和族裔产生不利影响。
