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Ethnicity does not affect outcomes of coronary angioplasty
1Section of Cardiology, Washington Hospital Center, District of Columbia, USA.
Insights
Minority ethnic groups, including African-Americans and Hispanics, experience similar success rates and complication rates for percutaneous transluminal coronary interventions (PTCI) compared to Caucasians. This study found no significant differences in outcomes after adjusting for baseline characteristics.
Area of Science:
- Cardiovascular Medicine
- Health Disparities
- Interventional Cardiology
Background:
- Access to quality healthcare, particularly complex procedures, may be limited for minority and lower socioeconomic groups.
- Caucasians undergo coronary artery bypass grafting (CABG) and percutaneous transluminal coronary interventions (PTCI) twice as often as African-Americans.
- Existing data suggest African-Americans may benefit less from CABG compared to Caucasians.
Purpose of the Study:
- To investigate if outcomes of catheter-based coronary angioplasty (PTCI) are less favorable in minority populations.
- To compare PTCI procedural success and complication rates across different ethnic groups.
Main Methods:
- Analysis of in-hospital outcomes for 6,559 consecutive patients undergoing PTCI.
- Ethnicity classification: 79.8% Caucasian, 13.2% African-American, 7.0% Hispanic, and 37 categorized as "other".
- Inclusion of 12 baseline clinical, angiographic, and procedural characteristics; hospital complications identified by quality assurance nurses.
Main Results:
- Significant differences in baseline characteristics were observed between ethnic groups.
- Univariate analysis showed higher mortality in Hispanics (2.0%) vs. Caucasians (0.7%) and African-Americans (0.8%), p=0.008.
- After adjusting for baseline characteristics, the difference in mortality was not statistically significant.
Conclusions:
- This analysis indicates equal procedural success and hospital complication rates for PTCI in African-American and Hispanic populations compared to Caucasians.
- Findings contrast with previous studies on CABG outcomes, suggesting favorable results for PTCI in minority groups.
- PTCI offers comparable outcomes across diverse ethnic groups, challenging prior assumptions about disparities in complex cardiac procedures.
Background:
Access to high quality medical care and especially to complex procedures may be adversely affected in members of a minority ethnic group or a lower socioeconomic class. For example, Caucasians undergo coronary artery bypass grafting (CABG) or percutaneous transluminal coronary interventions (PTCI) twice as frequently as African-Americans. Data exist to suggest that African-Americans derive less benefit than Caucasians from CABG.
Hypothesis:
We investigated the possibility that outcomes of catheter-based coronary angioplasty might also be less favorable in minority populations.
Methods:
We analyzed in-hospital outcomes in 6,559 consecutive patients who underwent PTCI in our laboratory. In 37 ethnicity was classified as "other," 5,203 (79.8%) were identified as Caucasians, 863 (13.2%), as African-Americans, and 456 (7.0%), as Hispanics. Twelve baseline clinical, angiographic, and procedural characteristics were entered into a computerized data base. Hospital complications were identified by trained quality assurance nurses.
Results:
Substantial differences in baseline characteristics existed between the populations. Despite these differences, on univariate comparison of ethnicity and outcome, no differences between ethnic groups were found with a single exception. Mortality in Hispanics was higher than in the other two populations. (2.0 vs. 0.7 and 0.8%, respectively, p = 0.008). However, when this was adjusted for baseline characteristics, the difference was not significant.
Conclusions:
In contrast to previous studies suggesting less favorable outcomes of CABG in African-American patients, this analysis demonstrates an equal frequency of procedural success and rate of hospital complications for PTCI in that population, in Hispanics, and in Caucasians.