癌症患者 TAVR 结果的种族差异

IF 2.8 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Frontiers in Cardiovascular Medicine Pub Date : 2024-09-11 DOI:10.3389/fcvm.2024.1416092

Ethan D. Kotloff, Yash Desai, Rohan Desai, Christopher Messner, Sergey Gnilopyat, Mark Sonbol, Abdullah Aljudaibi, Ai Tarui, Juwan Ives, Nisarg Shah, Ishan Vaish, Diljon Chahal, Brian Barr, Manu Mysore

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引用次数: 0

摘要

背景癌症疗法的进步和癌症患者生存率的提高导致越来越多的患者同时患有癌症和严重的主动脉瓣狭窄（AS）。经导管主动脉瓣置换术（TAVR）已被证明是此类患者的一种安全有效的治疗选择。在癌症治疗和经导管主动脉瓣置换术的使用和疗效方面，种族差异已得到证实。本研究的目的是调查癌症患者 TAVR 治疗结果的种族差异。方法：研究纳入了 343 名癌症患者，他们在一个中心接受了为期 6 年的 TAVR 治疗。主要终点是 1 年死亡率、中风和出血的综合结果。次要结果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。结果不同种族的基线特征（包括年龄、性别、体重指数、内科合并症、STS 评分和超声心动图参数）相似，但黑人癌症患者的 CKD（50.0% 对 26.6%，P = 0.005）和 ESRD（18.4% 对 4.9%，P = 0.005）发病率明显高于白人。在1年死亡率、中风和大出血的复合终点方面，黑人癌症患者的预后呈恶化趋势（35.7% vs. 22.6%，p = 0.095），主要原因是1年死亡率较高（31.0% vs. 17.6%，p = 0.065）。黑人癌症患者的30天死亡率是白人癌症患者的两倍（4.8% vs. 2.3%，p = 0.018）。结论与白人癌症患者相比，黑人癌症患者的TAVR结果有恶化趋势，围手术期并发症发生率和死亡率更高。还需要进一步研究，以阐明导致结果种族差异的结构、社会经济和生物学因素。

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Racial disparities in TAVR outcomes in patients with cancer

BackgroundAdvances 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.ObjectivesThe purpose of this study was to investigate racial disparities in outcomes of TAVR in cancer patients.Methods343 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.ResultsBaseline 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%, p = 0.005) and ESRD (18.4% vs. 4.9%, p = 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%, p = 0.095), primarily driven by higher 1-year mortality (31.0% vs. 17.6%, p = 0.065). 30-day mortality was twice as high in black cancer patients than in white cancer patients (4.8% vs. 2.3%, p = 0.018).ConclusionsThere 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.

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来源期刊

Frontiers in Cardiovascular Medicine Medicine-Cardiology and Cardiovascular Medicine

CiteScore

3.80

自引率

11.10%

发文量

3529

审稿时长

14 weeks

期刊介绍： Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers? At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.