黒人と白人のメディケア受給者におけるPCI中の補助画像と生理学:利用パターンと結果の格差
Frank A Medina1,2, Ramya C Mosarla3, Joseph M Kim1,4
1Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA. (F.A.M., J.M.K., S.L., Y.S., R.W.Y., E.A.S.).
Circulation. Cardiovascular interventions
|August 27, 2025
まとめ
黒人成人は,皮膚経冠動脈介入 (PCI) の間,血管内イメージング (IVI) と侵襲的生理学 (IP) の指導を少なく受けました. すべてのIVI/ IPで改善した結果にもかかわらず,黒人患者は全体的にPCIの結果を悪化させた.
科学分野:
- 心血管医学
- 介入心臓科
- 健康 の 格差
背景:
- 皮膚経冠動脈干渉 (PCI) の間における血管内画像 (IVI) と侵襲的生理学 (IP) の利用と結果における人種差異は,米国では十分に文書化されていない.
- これらの違いを理解することは 心血管疾患のケアにおける不平等を 解決するために不可欠です
研究 の 目的:
- 黒人と白人の患者で,PCI中にIVIとIPの使用における人種的差異を調査する.
- 人種グループ間のIVIとIPによるPCIの臨床結果を比較する.
主な方法:
- 2016年から2023年までの医療保険料請求のデータ分析
- 多変数ロジスティック回帰を用いて,人種とIVI/IPの使用の関連性を評価した.
- 心筋梗塞,再循環,死亡を含む2年間の主要な心血管不良事件 (MACE) の割合を比較するためにコックス回帰を用いた.
主要な成果:
- この研究には148万人以上のPCI患者が参加し,黒人成人はコホートの5. 9%を占めた.
- 黒人の患者は,調整後の白人の患者と比較して,IVI (OR,0. 94) またはIP (OR,0. 83) のガイドラインを受け取る可能性が低い.
- IVIとIPのガイドラインは,両方のグループでMACEのリスクを低下させたが,黒人成人は,白人成人に比べて2年後のMACEの調整されたリスク (HR,1. 02) を高めた.
結論:
- 血管内イメージングと侵襲的生理学ガイドは,黒人と白人の両方のPCIの結果を改善します.
- しかしこれらの有益な技術は 黒人患者では十分に活用されていません
- PCIの利用と結果の持続的な差異は,黒人の患者よりも白人の患者を好む.
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