11 The influence of ethnicity on clinical outcomes following transcatheter aortic valve implantation (TAVI)
Notice bibliographique
Résumé
Background We have previously shown that minority ethnic groups are proportionately represented in the cohort of patients undergoing TAVI at our centre. This was an encouraging finding, however, the relationship between ethnicity and clinical outcomes following TAVI in our local population is unknown. Concerningly, this finding is reflected in a wider lack of published work on this important topic. Aim To analyse the influence of ethnicity on outcomes following TAVI in a continuous cohort of patients treated at a tertiary referral centre in the UK over the last 10 years. Methods A retrospective analysis of 1049 patients (9.7% non-white) undergoing TAVI from 2013 to 2023 was conducted. Data was submitted to National Institute for Cardiovascular Outcomes Research (NICOR) TAVI database. Primary outcomes included death and composite 3-point major adverse cardiac events (MACE) (death, from any cause, non-fatal myocardial infarction, and stroke) before discharge during TAVI admission. Post-TAVI survival time was also assessed. Given the relatively low number of events, a composite group of non-white patients was created. Variables were compared using Chi-squared or student’s t-test. Cox regression analysis was performed for independent predictors of survival. Procedural outcomes were adjusted using multivariate regression. Results In our cohort of 1049 TAVI patients, 90.3% were white, 2.4% black, 5.5% Asian, 0.2% Chinese and 1.5% other/unknown. At baseline, non-white patients in our cohort were 3 years younger, (83.0 ± 7.0 vs 80.0 ± 7.8, p < 0.01) but more likely to have diabetes (25.4% vs 48%, p < 0.01), New York Heart Association (NYHA) class IV Heart Failure (30.4% vs 41.2%, p = 0.03) and experience Canadian Cardiovascular Society (CCS) class IV angina (1.2% vs 4.9%, p = 0.01). Non-white patients were more likely to undergo non-elective TAVI (15.0% vs 27.5%, p < 0.01) and received smaller valves (28.22 mm ±2.855 vs 26.61 mm ±2.754, p <.001). Rates of death (2.5% vs 2.0%, p = 1) and 3-point MACE from TAVI to discharge (5.0% vs 6.9%, p = 0.4) did not differ significantly between groups. Post TAVI median survival between did not significantly differ (1538 days vs 1626 days, p = 0.8). Cox-regression showed ethnicity is not an independent predictor of survival (p=0.256) Categorical data presented as (white % vs non-white %). Continuous as (white ± standard deviation vs non-white ± standard deviation). Odds ratios adjusted. Conclusion Short term outcomes and median survival following TAVI do not significantly differ between white and non-white patients in our centre. However, non-white patients were found to have worse symptoms of heart failure and angina at baseline. Non-white patients were also more likely to undergo non-elective TAVI. This raises the possibility of delayed recognition or referral of aortic stenosis in non-white patients. Further, dedicated work is warranted to explore the reproducibility of this finding in larger, multi-centre cohorts. Conflict of Interest Nil
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».