Impact of sex, race and socioeconomic status on survival after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension

Austin Y Su; Alice Vinogradsky; Amy S Wang; Yuming Ning; Elizabeth Abrahams; Matthew Bacchetta; Paul Kurlansky; Erika B Rosenzweig; Koji Takeda

doi:10.1093/ejcts/ezac364

Impact of sex, race and socioeconomic status on survival after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension

Eur J Cardiothorac Surg. 2022 Jul 11;62(2):ezac364. doi: 10.1093/ejcts/ezac364.

Authors

Austin Y Su¹, Alice Vinogradsky¹, Amy S Wang¹, Yuming Ning², Elizabeth Abrahams³, Matthew Bacchetta⁴, Paul Kurlansky¹, Erika B Rosenzweig³, Koji Takeda¹

Affiliations

¹ Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA.
² Department of Surgery, Center of Innovation and Outcomes Research, Columbia University, New York, NY, USA.
³ Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.
⁴ Departments of Thoracic and Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.

PMID: 35809067
DOI: 10.1093/ejcts/ezac364

Abstract

Objectives: Pulmonary thromboendarterectomy (PTE) is a definitive treatment for chronic thromboembolic pulmonary hypertension. Demographic-based disparities in PTE outcomes have not been well-studied.

Methods: We reviewed all patients who underwent PTE for chronic thromboembolic pulmonary hypertension between 2009 and 2019 at our institution, tracking demographic information including self-identified race, preoperative characteristics and 2-year survival. Socioeconomic status was assessed using the zip code-linked Distressed Communities Index, a validated holistic measure of community well-being. Survival was estimated using Kaplan-Meier method and factors associated with mortality were estimated using Cox regression.

Results: Of 235 PTE patients, 101 (42.9%) were white and 87 (37.0%) were black. White patients had a higher median age at surgery (57 vs 51 years, P = 0.035) and a lower degree of economic distress (33.6 vs 61.2 percentile, P < 0.001). Regarding sex, 106 (45.1%) patients were male and 129 (53.6%) were female. Male patients had a higher median age (59 vs 50 years, P = 0.004), greater rates of dyslipidaemia (34% vs 20.2%, P = 0.025), a lower ejection fraction (55% vs 57%, P = 0.046) and longer cross-clamp (77 vs 67.50 min, P = 0.004) and circulatory arrest times (42 vs 37.50 min, P = 0.007). No difference was observed in unadjusted 2-year survival after PTE between patients stratified by race and sex (P = 0.35). After adjustment for clinically relevant variables, neither socioeconomic status, sex nor race were associated with mortality in Cox proportional hazard analysis.

Conclusions: Sex, socioeconomic status and race were not associated with adverse outcomes after PTE in our single-centre experience.

Keywords: Chronic thromboembolic pulmonary hypertension; Distressed communities index; Outcome disparities; Pulmonary thromboendarterectomy; Socioeconomic status.

Publication types

Review

MeSH terms

Chronic Disease
Endarterectomy / methods
Female
Humans
Hypertension, Pulmonary*
Male
Middle Aged
Pulmonary Embolism* / complications
Social Class
Treatment Outcome