Kotloff Ethan D, Desai Yash, Desai Rohan, Messner Christopher, Gnilopyat Sergey, Sonbol Mark, Aljudaibi Abdullah, Tarui Ai, Ives Juwan, Shah Nisarg, Vaish Ishan, Chahal Diljon, Barr Brian, Mysore Manu
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
Front Cardiovasc Med. 2024 Sep 11;11:1416092. doi: 10.3389/fcvm.2024.1416092. eCollection 2024.
Advances in cancer therapies and improvement in survival of cancer patients have led to a growing number of patients with both cancer and severe aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has been shown to be a safe and effective treatment option for this patient population. There are established racial disparities in utilization and outcomes of both cancer treatments and TAVR. However, the effect of race on TAVR outcomes in cancer patients has not been studied.
The purpose of this study was to investigate racial disparities in outcomes of TAVR in cancer patients.
343 patients with cancer who underwent TAVR at a single center over a 6-year period were included in the study. The primary endpoint was a composite of 1-year mortality, stroke, and bleeding. Secondary outcomes included individual components of the primary endpoint as well as 30-day mortality, structural complications, vascular access complications, and conduction system complications. Outcomes were compared between black and white patients by comparing incidence rates.
Baseline characteristics including age, sex, BMI, medical comorbidities, STS score, and echocardiographic parameters were similar between races, aside from significantly higher rates of CKD (50.0% vs. 26.6%, = 0.005) and ESRD (18.4% vs. 4.9%, = 0.005) in black compared to white cancer patients. There was a trend toward worse outcomes in black cancer patients with regard to a composite endpoint of 1-year mortality, stroke, and major bleeding (35.7% vs. 22.6%, = 0.095), primarily driven by higher 1-year mortality (31.0% vs. 17.6%, = 0.065). 30-day mortality was twice as high in black cancer patients than in white cancer patients (4.8% vs. 2.3%, = 0.018).
There is a trend toward worse TAVR outcomes in black cancer patients, with higher periprocedural complication rates and mortality, compared to white cancer patients. Further studies are needed to elucidate the structural, socioeconomic, and biological factors that contribute to racial differences in outcomes.
癌症治疗的进展以及癌症患者生存率的提高，导致同时患有癌症和严重主动脉瓣狭窄（AS）的患者数量不断增加。经导管主动脉瓣置换术（TAVR）已被证明是针对这一患者群体的一种安全有效的治疗选择。在癌症治疗和TAVR的使用及结果方面存在既定的种族差异。然而，种族对癌症患者TAVR结果的影响尚未得到研究。
本研究的目的是调查癌症患者TAVR结果中的种族差异。
本研究纳入了在6年期间于单一中心接受TAVR的343例癌症患者。主要终点是1年死亡率、中风和出血的综合指标。次要结局包括主要终点的各个组成部分以及30天死亡率、结构并发症、血管通路并发症和传导系统并发症。通过比较发病率来比较黑人和白人患者的结局。
除黑人癌症患者的慢性肾脏病（CKD）（50.0%对26.6%，P = 0.005）和终末期肾病（ESRD）（18.4%对4.9%，P = 0.005）发生率显著高于白人外，不同种族之间的基线特征，包括年龄、性别、体重指数、合并症、胸外科医师协会（STS）评分和超声心动图参数相似。在1年死亡率、中风和大出血的综合终点方面，黑人癌症患者的结局有变差的趋势（35.7%对22.6%，P = 0.095），主要是由较高的1年死亡率（31.0%对17.6%，P = 0.065）驱动。黑人癌症患者的30天死亡率是白人癌症患者的两倍（4.8%对2.3%，P = 0.018）。
与白人癌症患者相比，黑人癌症患者的TAVR结局有变差的趋势，围手术期并发症发生率和死亡率更高。需要进一步研究以阐明导致结局种族差异的结构、社会经济和生物学因素。
