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Comparison of baseline characteristics and one-year outcomes between African-Americans and Caucasians undergoing
Laurent Leborgne1, Edouard Cheneau, Roswitha Wolfram
1Cardiovascular Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
Insights
African-Americans undergoing percutaneous coronary intervention (PCI) have more health issues but similar clinical success compared to Caucasians. However, they face higher mortality rates one year after PCI.
Area of Science:
- Cardiology
- Health Disparities
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) incidence is higher in African-Americans.
- African-Americans are less likely to receive coronary revascularization compared to Caucasians.
- Limited data exists on the outcomes of African-Americans undergoing percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate race-based disparities in baseline characteristics.
- To compare short- and long-term outcomes after PCI between African-Americans and Caucasians.
Main Methods:
- Analysis of a consecutive series of 1,268 African-Americans and 10,561 Caucasians undergoing PCI (1994-2001).
- Exclusion of patients hospitalized for acute myocardial infarction.
- Propensity score adjustment and multivariate analysis to control for confounding factors.
Main Results:
- African-Americans were older, more likely female, and had higher comorbidity burden.
- In-hospital clinical success rates were similar; however, African-Americans had more combined in-hospital death and Q-wave myocardial infarction events (p=0.03).
- At 1 year, African-Americans showed a lower target lesion revascularization rate but a 50% higher mortality rate (9.8% vs 6.4%, p<0.001), remaining a significant predictor in multivariate analysis (HR 1.35, p=0.01).
Conclusions:
- African-Americans undergoing PCI present with more comorbidities than Caucasians.
- Despite comparable procedural success, 1-year outcomes, particularly mortality, are worse for African-Americans after PCI.
- Race remains a significant predictor of increased long-term mortality following PCI.
Abstract:
The objectives of this study were to determine whether there are race-based differences in baseline characteristics and in short- or long-term outcomes after percutaneous coronary intervention (PCI). African-Americans have a higher incidence of coronary artery disease but are less likely to undergo coronary revascularization than Caucasians. Little is known about the profiles and outcomes of African-Americans who undergo PCI. Consecutive series of 1,268 African-Americans and 10,561 Caucasians with symptomatic coronary artery disease who underwent PCI between January 1994 and June 2001 were analyzed. Patients hospitalized for acute myocardial infarction were excluded. African-Americans were older, were more likely to be women, and had more co-morbid baseline conditions compared with Caucasians. Preprocedure lesion characteristics were similar with regard to vessel size, length, and complexity. The rate of clinical success did not differ between the groups. African-Americans experienced more in-hospital combined events of death and Q-wave myocardial infarction (p = 0.03). After propensity score adjustment, African-American race was not an independent predictor for in-hospital events. At 1 year, African-Americans had a slightly lower rate of target lesion revascularization and a 50% higher rate of death (9.8% vs. 6.4%, p <0.001), with a relative risk of 1.52 (95% confidence interval 1.22 to 1.89). In multivariate analysis, African-American race remained a significant predictor of increased 1-year mortality (hazard ratio 1.35, 95% confidence interval 1.06 to 1.71, p = 0.01). African-Americans undergoing angioplasty have more co-morbid baseline conditions than Caucasians. Despite similar clinical success, 1-year outcomes are impaired in African-Americans.
