黑人和白人医疗保险受益者在PCI期间的辅助成像和生理学:利用模式和结果的差异
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
概括
在穿皮冠状动脉干预 (PCI) 期间,黑人成年人接受了较少的血管内成像 (IVI) 和侵入性生理学 (IP) 指导. 尽管IVI/ IP对所有患者的结果有所改善,但黑人患者的整体PCI结果较差.
科学领域:
- 心血管医学
- 干预心脏病学
- 健康上的差异
背景情况:
- 在美国,皮肤冠状动脉干预 (PCI) 过程中,血管内成像 (IVI) 和侵入性生理学 (IP) 的利用和结果的种族差异没有得到充分记录.
- 了解这些差异对于解决心血管保健方面的不平等至关重要.
研究的目的:
- 研究黑人和白人患者在PCI期间使用IVI和IP的种族差异.
- 在种族群体之间比较IVI和IP指导的PCI的临床结果.
主要方法:
- 对2016-2023年医疗保险服务费索赔数据的分析.
- 使用多变量逻辑回归来评估种族与IVI/IP使用之间的关联.
- 使用考克斯回归来比较2年的主要心血管不良事件 (MACE) 率,包括心肌梗塞,重复血管化和死亡,调整基线特征.
主要成果:
- 该研究包括超过148万名PCI患者,黑人成年人占该队列的5. 9%.
- 与调整后的白人患者相比,黑人患者接受IVI (OR,0. 94) 或IP (OR,0. 83) 指导的可能性较低.
- 虽然IVI和IP指导在两组中降低了MACE风险,但与白人成年人相比,黑人成年人的调整后2年MACE风险更高 (HR,1. 02).
结论:
- 血管内成像和侵入性生理指导改善了黑人和白人患者的PCI结果.
- 然而,这些有益的技术在黑人患者中未得到充分利用.
- 在PCI利用和结果的持续差异有利于白人患者而不是黑人患者.
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