Background

Data on the patient characteristics and health outcomes of Indigenous Australians having revascularisation for treatment of coronary artery disease are scarce. The aim of this study was to assess differences in patient characteristics, presentations, and outcomes among Indigenous and non-Indigenous Australians having percutaneous coronary intervention (PCI) in urban and larger regional centres in Victoria, Australia.

Methods

In this multicentre, prospective, observational cohort study, data were prospectively collected from six government-funded tertiary hospitals in the state of Victoria, Australia. The Melbourne Interventional Group PCI registry was used to identify patients having PCI at Victorian metropolitan and large regional hospitals between Jan 1, 2005, and Dec 31, 2018. The primary outcome was long-term mortality. Secondary outcomes were 30 day mortality and 30 day major adverse cardiovascular events (MACE), defined as a composite endpoint of death, myocardial infarction, and target-vessel revascularisation. Regression analyses, adjusted for clinically relevant covariates and geographical and socioeconomic indices, were used to establish the influence of Indigenous status on these study outcomes.

Findings

41 146 patient procedures were entered into the registry, of whom 179 (0·4%) were recorded as identifying as Indigenous Australian, 39 855 (96·9%) were not Indigenous Australian, and 1112 (2·7%) had incomplete data regarding ethnicity and were excluded. Compared with their non-Indigenous counterparts, Indigenous patients were younger, more often women, and more likely to have comorbidities. Indigenous Australians were also more likely to live in a regional community and areas of socioeconomic disadvantage. Procedural success and complication rates were similar for Indigenous and non-Indigenous patients having PCI. At 30 day follow-up, Indigenous Australians were more likely to be taking optimal medical therapy, although overall follow-up rates were lower and prevalence of persistent smoking was higher. Multivariable analysis showed that Indigenous status was independently associated with increased risk of long-term mortality (hazard ratio 2·49, 95% CI 1·79–3·48; p<0·0001), 30 day mortality (odds ratio 2·78, 95% CI 1·09–7·12; p=0·033), and 30-day MACE (odds ratio 1·87, 95% CI 1·03–3·39; p=0·039).

Interpretation

Indigenous Australians having PCI in urban and larger regional centres are at increased risk of mortality and adverse cardiac events. Clinically effective and culturally safe care pathways are urgently needed to improve health outcomes among Indigenous Australians who are having PCI.

Funding

National Health and Medical Research Council, National Heart Foundation.

中文翻译：

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澳大利亚维多利亚原住民和非原住民经皮冠状动脉介入治疗结果的差异：一项多中心、前瞻性、观察性、队列研究

背景

关于为治疗冠状动脉疾病而进行血运重建的澳大利亚土著人的患者特征和健康结果的数据很少。本研究的目的是评估在澳大利亚维多利亚的城市和更大的区域中心接受经皮冠状动脉介入治疗 (PCI) 的土著和非土著澳大利亚人在患者特征、表现和结果方面的差异。

方法

在这项多中心、前瞻性、观察性队列研究中，前瞻性地收集了来自澳大利亚维多利亚州六家政府资助的三级医院的数据。墨尔本干预组 PCI 登记处用于确定 2005 年 1 月 1 日至 2018 年 12 月 31 日期间在维多利亚州大都会和大型地区医院接受 PCI 的患者。主要结果是长期死亡率。次要结局是 30 天死亡率和 30 天主要不良心血管事件 (MACE)，定义为死亡、心肌梗死和靶血管血运重建的复合终点。回归分析，根据临床相关协变量以及地理和社会经济指数进行调整，用于确定土著地位对这些研究结果的影响。

发现

41 146 例患者手术被录入登记处，其中 179 例 (0·4%) 被记录为澳大利亚土著，39 855 例 (96·9%) 不是澳大利亚土著，1112 例 (2·7%)有关种族的数据被排除在外。与非土著患者相比，土著患者更年轻，女性更多，并且更有可能患有合并症。澳大利亚原住民也更有可能生活在偏远社区和社会经济劣势地区。进行 PCI 的土著和非土著患者的手术成功率和并发症发生率相似。在 30 天的随访中，尽管总体随访率较低且持续吸烟的流行率较高，但澳大利亚土著人更有可能接受最佳药物治疗。

解释

在城市和较大的区域中心进行 PCI 的澳大利亚土著居民死亡和心脏不良事件的风险增加。迫切需要临床有效和文化安全的护理途径来改善接受 PCI 的澳大利亚土著人的健康结果。

资金

国家健康和医学研究委员会，国家心脏基金会。