Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; West Haven VA Medical Center, West Haven, Connecticut.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Am J Cardiol. 2024 Sep 1;226:40-49. doi: 10.1016/j.amjcard.2024.05.021. Epub 2024 Jun 2.
Use of peripheral vascular intervention (PVI) for intermittent claudication (IC) continues to expand, but there is uncertainty whether baseline demographics, procedural techniques and outcomes differ by sex, race, and ethnicity. This study aimed to examine amputation and revascularization rates up to 4 years after femoropopliteal (FP) PVI for IC by sex, race, and ethnicity. Patients who underwent FP PVI for IC between 2016 and 2020 from the PINC AI Healthcare Database were analyzed. The primary outcome was any index limb amputation, assessed by Kaplan-Meier estimate. Secondary outcomes included index limb major amputation, repeat revascularization, and index limb repeat revascularization. Unadjusted and adjusted hazard ratios (HRs) were estimated using Cox proportional hazard regression models. This study included 19,324 patients with IC who underwent FP PVI, with 41.2% women, 15.6% Black patients, and 4.7% Hispanic patients. Women were less likely than men to be treated with atherectomy (45.1% vs 47.8%, p = 0.0003); Black patients were more likely than White patients to receive atherectomy (50.7% vs 44.9%, p <0.001), and Hispanic patients were less likely than non-Hispanic patients to receive atherectomy (41% vs 47%, p = 0.0004). Unadjusted rates of any amputation were similar in men and women (6.4% for each group, log-rank p = 0.842), higher in Black patients than in White patients (7.8% vs 6.1%, log-rank p = 0.007), and higher in Hispanic patients than in non-Hispanic patients (8.8% vs 6.3%, log-rank p = 0.031). After adjustment for baseline characteristics, Black race was associated with higher rates of repeat revascularization (adjusted HR 1.13, 95% confidence interval 1.04 to 1.22) and any FP revascularization (adjusted HR 1.10, 95% confidence interval 1.01 to 1.20). No statistical difference in amputation rate was observed among comparison groups. Women and men with IC had similar crude and adjusted amputation and revascularization outcomes after FP PVI. Black patients had higher repeat revascularization and any FP revascularization rates than did White patients. Black and Hispanic patients had higher crude amputation rates, but these differences were attenuated by adjustment for baseline characteristics. Black patients were more likely to receive atherectomy and had higher rates of any repeat revascularization and specifically FP revascularization. Further study is necessary to determine whether these patterns are related to disease-specific issues or practice-pattern differences among different populations.
外周血管介入 (PVI) 在间歇性跛行 (IC) 中的应用不断扩大，但尚不确定基线人口统计学、手术技术和结局是否因性别、种族和民族而不同。本研究旨在通过性别、种族和民族检查股腘 PVI 后 4 年内的截肢和血运重建率。分析了 2016 年至 2020 年期间 PINC AI 医疗保健数据库中接受股腘 PVI 治疗 IC 的患者。主要结局是通过 Kaplan-Meier 估计评估任何索引肢体截肢。次要结局包括索引肢体主要截肢、重复血运重建和索引肢体重复血运重建。使用 Cox 比例风险回归模型估计未调整和调整后的风险比 (HR)。这项研究包括 19324 名接受股腘 PVI 治疗的 IC 患者，其中 41.2%为女性，15.6%为黑人患者，4.7%为西班牙裔患者。与男性相比，女性接受旋切术治疗的可能性较小（45.1%比 47.8%，p=0.0003）；黑人患者接受旋切术治疗的可能性大于白人患者（50.7%比 44.9%，p<0.001），而西班牙裔患者接受旋切术治疗的可能性小于非西班牙裔患者（41%比 47%，p=0.0004）。男性和女性的未调整截肢率相似（每组 6.4%，log-rank p=0.842），黑人患者高于白人患者（7.8%比 6.1%，log-rank p=0.007），西班牙裔患者高于非西班牙裔患者（8.8%比 6.3%，log-rank p=0.031）。在调整基线特征后，黑种人种族与更高的重复血运重建率（调整后的 HR 1.13，95%置信区间 1.04 至 1.22）和任何 FP 血运重建率（调整后的 HR 1.10，95%置信区间 1.01 至 1.20）相关。在比较组中，未观察到截肢率的统计学差异。股腘 PVI 后，女性和男性 IC 的截肢和血运重建结果相似。与白人患者相比，黑人患者的重复血运重建和任何 FP 血运重建率更高。黑人和西班牙裔患者的截肢率较高，但通过调整基线特征，这些差异减弱。黑人患者更有可能接受旋切术治疗，且重复血运重建和特定 FP 血运重建的发生率更高。需要进一步研究以确定这些模式是否与特定疾病问题或不同人群之间的实践模式差异有关。
