JAMA cardiology · 2017
Comparative Outcomes After Percutaneous Coronary Intervention Among Black and White Patients Treated at US Veterans Affairs Hospitals.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Kobayashi Taisei, Glorioso Thomas J, Armstrong Ehrin J, Maddox Thomas M, Plomondon Mary E, Grunwald Gary K, Bradley Steven M, Tsai Thomas T, Waldo Stephen W, Rao Sunil V, Banerjee Subhash, Nallamothu Brahmajee K, Bhatt Deepak L, Rene A Garvey, Wilensky Robert L, Groeneveld Peter W, Giri Jay
Аннотация
IMPORTANCE: Current comparative outcomes among black and white patients treated with percutaneous coronary intervention (PCI) in the Veterans Affairs (VA) health system are not known.
OBJECTIVE: To compare outcomes between black and white patients undergoing PCI in the VA health system.
DESIGN, SETTING, AND PARTICIPANTS: This study compared black and white patients who underwent PCI between October 1, 2007, and September 30, 2013, at 63 VA hospitals using data recorded in the VA Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories (CART-CL) program. A generalized linear mixed model with a random intercept for site assessed the relative difference in odds of outcomes between black and white patients. The setting was integrated institutionalized hospital care. Excluded were all patients of other races or those with multiple listed races and those with missing data regarding race or the diagnostic cardiac catheterization. The dates of analysis were January 7, 2016, to April 17, 2017.
EXPOSURE: Percutaneous coronary intervention at a VA hospital.
MAIN OUTCOMES AND MEASURES: The primary outcome was 1-year mortality. Secondary outcomes were 30-day all-cause readmission rates, 30-day acute kidney injury, 30-day blood transfusion, and 1-year readmission rates for myocardial infarction. In addition, variations in procedural and postprocedural care were examined, including the use of intravascular ultrasound, optical coherence tomography, fractional flow reserve measurements, bare-metal stents, postprocedural medications, and radial access.
RESULTS: A total of 42 391 patients (13.3% black and 98.4% male; mean [SD] age, 65.2 [9.1] years) satisfied the inclusion and exclusion criteria. In unadjusted analyses, black patients had higher rates of 1-year mortality (7.1% vs 5.9%, P < .001) as well as secondary outcomes of 30-day acute kidney injury (20.8% vs 13.8%, P < .001), 30-day blood transfusion (3.4% vs 2.7%, P < .01), and 1-year readmission rates for myocardial infarction (3.3% vs 2.7%, P = .01) compared with white patients. After adjustment for demographics, comorbidities, and procedural characteristics, odds for 1-year mortality (odds ratio, 1.04; 95% CI, 0.90-1.19) were not different between black and white patients. There were also no differences in secondary outcomes with the exception of a higher rate of adjusted 30-day acute kidney injury (odds ratio, 1.22; 95% CI, 1.10-1.36).
CONCLUSIONS AND RELEVANCE: While black patients had a higher rate of mortality than white patients in unadjusted analyses, race was not independently associated with 1-year mortality among patients undergoing PCI in VA hospitals.
OBJECTIVE: To compare outcomes between black and white patients undergoing PCI in the VA health system.
DESIGN, SETTING, AND PARTICIPANTS: This study compared black and white patients who underwent PCI between October 1, 2007, and September 30, 2013, at 63 VA hospitals using data recorded in the VA Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories (CART-CL) program. A generalized linear mixed model with a random intercept for site assessed the relative difference in odds of outcomes between black and white patients. The setting was integrated institutionalized hospital care. Excluded were all patients of other races or those with multiple listed races and those with missing data regarding race or the diagnostic cardiac catheterization. The dates of analysis were January 7, 2016, to April 17, 2017.
EXPOSURE: Percutaneous coronary intervention at a VA hospital.
MAIN OUTCOMES AND MEASURES: The primary outcome was 1-year mortality. Secondary outcomes were 30-day all-cause readmission rates, 30-day acute kidney injury, 30-day blood transfusion, and 1-year readmission rates for myocardial infarction. In addition, variations in procedural and postprocedural care were examined, including the use of intravascular ultrasound, optical coherence tomography, fractional flow reserve measurements, bare-metal stents, postprocedural medications, and radial access.
RESULTS: A total of 42 391 patients (13.3% black and 98.4% male; mean [SD] age, 65.2 [9.1] years) satisfied the inclusion and exclusion criteria. In unadjusted analyses, black patients had higher rates of 1-year mortality (7.1% vs 5.9%, P < .001) as well as secondary outcomes of 30-day acute kidney injury (20.8% vs 13.8%, P < .001), 30-day blood transfusion (3.4% vs 2.7%, P < .01), and 1-year readmission rates for myocardial infarction (3.3% vs 2.7%, P = .01) compared with white patients. After adjustment for demographics, comorbidities, and procedural characteristics, odds for 1-year mortality (odds ratio, 1.04; 95% CI, 0.90-1.19) were not different between black and white patients. There were also no differences in secondary outcomes with the exception of a higher rate of adjusted 30-day acute kidney injury (odds ratio, 1.22; 95% CI, 1.10-1.36).
CONCLUSIONS AND RELEVANCE: While black patients had a higher rate of mortality than white patients in unadjusted analyses, race was not independently associated with 1-year mortality among patients undergoing PCI in VA hospitals.
Предметные рубрики MeSH
Acute Coronary SyndromeAcute Kidney InjuryBlack or African AmericanAgedAngina, StableAngina, UnstableBlood TransfusionCoronary Artery DiseaseCoronary StenosisFractional Flow Reserve, MyocardialHospitals, VeteransHumansLinear ModelsMaleMiddle AgedMortalityMyocardial InfarctionNon-ST Elevated Myocardial InfarctionOdds RatioPatient ReadmissionPercutaneous Coronary InterventionPostoperative CareRadial ArteryST Elevation Myocardial InfarctionStentsTomography, Optical CoherenceTreatment OutcomeUltrasonography, InterventionalUnited StatesUnited States Department of Veterans AffairsWhite People