Outcomes data for women and minority patients after percutaneous coronary intervention with everolimus-eluting stents are limited. Batchelor and coauthors assessed 1-year outcomes in patients enrolled in the PLATINUM Diversity study and the PROMUS Element Plus Post-Approval Study, including 1635 white men, 1863 women (white and minority), and 1059 minority patients (women and men). Compared with white men, the adjusted risk of death/myocardial infarction was higher among women and minority patients, and the adjusted risk of myocardial infarction was higher in minority patients. These differences were driven primarily by nonstent-related myocardial infarctions. Adverse events were also associated with social determinants of health, including widowhood and insurance status.
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Khera and coauthors examined surgical volume and in-hospital risk-standardized mortality rate (RSMR) in 682 hospitals between 2007 and 2011 using the Agency for Healthcare Research and Quality National Inpatient Sample. Among hospitals in the highest volume tertile for surgical aortic valve replacement, 36.0% were in the highest RSMR tertile, while 17.5% of hospitals in the lowest volume tertile were in the lowest RSMR tertile. Similar findings were observed for mitral valve surgery. Using volume to categorize hospitals for quality would misclassify 44.7% based on tertiles of RSMR. In an Editorial, Schaff comments that while high volumes of valve operations do not guarantee lowest early mortality, institutional and surgeon experience affect surgical results, and future studies should consider outcomes more broadly than hospital mortality alone.
The long-term association of coronary artery calcification (CAC) score and incident coronary heart disease (CHD) has not been studied comprehensively in metabolic syndrome and diabetes. Malik and coauthors studied 6751 individuals enrolled in the Multi-Ethnic Study of Atherosclerosis, of whom 881 (13.0%) had diabetes and 1738 (25.7%) had metabolic syndrome, with a mean follow-up of 11.1 years. They found that CAC score was independently associated with incident CHD in multivariable analyses, and the addition of CAC score resulted in a net reclassification index of 0.23 and 0.22 for those with diabetes and metabolic syndrome, respectively. Additionally, CAC score was predictive of CHD after controlling for diabetes duration of 10 years or more at baseline, insulin use, and glycemic control.
The relationship between physical activity and cardiovascular disease (CVD) in Chinese adults is uncertain. Bennett and coauthors investigated total, occupational, and nonoccupational physical activity in 487 334 adults (59.0% women) with no prior CVD history when enrolled from June 2004 July 2008 in 5 urban and 5 rural areas across China. Physical activity was mainly occupational activity (75% in men vs 50% in women). Total physical activity was inversely associated with risk of major vascular events, including major coronary events, ischemic stroke, intracerebral hemorrhage, and CVD death. These associations were similar in men and women. In an Invited Commentary, Lear and Yusuf address the global implications of these findings, pointing out that if the entire population met the World Health Organization physical activity guidelines, whether recreational or occupational, then this would prevent approximately 4.5 million premature deaths worldwide.