背景:死亡的主要原因,冠状动脉疾病(CAD)通常需要冠状动脉旁路移植术(CABG)和经皮冠状动脉介入治疗(PCI)等侵入性手术.土著和非土著澳大利亚人的心血管结果各不相同;然而,缺乏对这些差异的全面了解。
方法:为了比较土著和非土著澳大利亚人的PCI和CABG结果,我们进行了系统评价和荟萃分析.包括10项回顾性观察研究,这些研究检查了死亡率,心血管事件,合并症,和手术成功率。搜索了2014年至2024年的数据库,直接比较澳大利亚土著和非土著人口的研究是纳入标准之一。
结果:手术后30天内,接受PCI的澳大利亚土著居民合并症发生率较高,长期死亡率和MACE风险较高.同样,CABG术后土著患者的长期死亡率更高.文化安全,社会经济因素,以及影响治疗延误和获得护理的区域因素,所有受影响的差异。对于30天的死亡率,汇总分析显示比值比为1.04(95%CI0.78,1.40),表明没有有意义的差异。不利事件的总赔率比为1.07(95%CI0.86,1.33),这意味着土著群体和没有土著群体之间没有统计学上的显著差异。
结论:土著澳大利亚人在PCI和CABG手术后的心血管结局仍然更差,即使程序成功率相似。确保土著群体获得公平的心血管结果,针对潜在风险因素的靶向治疗,增加获得文化上适当的护理的机会,减少医疗保健障碍至关重要。
BACKGROUND: A major cause of death, coronary artery disease (CAD) often necessitates invasive procedures like coronary bypass grafting (CABG) and percutaneous coronary intervention (PCI). Cardiovascular outcomes vary between indigenous and non-indigenous Australian people; however, comprehensive knowledge of these differences is absent.
METHODS: To compare PCI and CABG results between indigenous and non-indigenous Australians, a systematic review and meta-analysis were carried out. Included were 10 retrospective observational studies that examined mortality, cardiovascular events, comorbidities, and operative success rates. Databases spanning 2014 to 2024 were searched, and research that directly compared Australia\'s indigenous and non-indigenous populations was among the inclusion criteria.
RESULTS: Within 30 days of surgery, indigenous Australians receiving PCI had greater rates of comorbidities and were at higher risk of long-term mortality and MACE. Similarly, there was a greater long-term death rate among indigenous patients following CABG. Cultural safety, socioeconomic factors, and regional factors affecting treatment delays and access to care all affected disparities. For 30-day mortality, the pooled analysis shows an odds ratio of 1.04 (95% CI 0.78, 1.40), indicating no meaningful difference. The total odds ratio for unfavorable occurrences is 1.07 (95% CI 0.86, 1.33), meaning there is no statistically significant difference between Indigenous groups and those that are not.
CONCLUSIONS: Indigenous Australians continue to have worse cardiovascular outcomes after PCI and CABG procedures, even with similar procedural success rates. To ensure equitable cardiovascular outcomes for indigenous groups, targeted therapies targeting underlying risk factors, increased access to culturally appropriate care, and decreased obstacles to healthcare access are critical.