Racial disparities in outcomes following percutaneous coronary intervention with drug-eluting stents
Michael A Gaglia1, Daniel H Steinberg, Tina L Pinto Slottow
1Washington Hospital Center, Washington, DC, USA.
Insights
African-Americans experienced higher adverse cardiac events after drug-eluting stent procedures. However, after adjusting for socioeconomic factors, race was not a significant predictor, indicating these factors explain the disparity.
Area of Science:
- Cardiovascular Medicine
- Health Disparities Research
- Interventional Cardiology
Background:
- African-Americans exhibit higher rates of adverse cardiac outcomes compared to non-African-Americans.
- Existing disparities persist even after accounting for comorbidities and socioeconomic status.
- Reduced referral rates for invasive cardiac procedures in African-Americans have been previously noted.
Purpose of the Study:
- To compare 1-year outcomes in African-American versus non-African-American patients post-percutaneous coronary intervention (PCI) with drug-eluting stents.
- To assess the independent contribution of African-American race to adverse cardiac events after PCI.
- To determine if socioeconomic status explains observed outcome disparities.
Main Methods:
- A clinical registry analysis of 1,221 African-American and 4,335 non-African-American patients undergoing PCI with drug-eluting stents.
- 1-year follow-up for major adverse cardiac events (MACE), including death, Q-wave myocardial infarction, and target vessel revascularization.
- Multivariable Cox proportional hazards regression, adjusting for socioeconomic status (median household income by zip code).
Main Results:
- African-American patients showed significantly higher rates of overall MACE (17.7% vs 12.4%), death (7.8% vs 5.4%), Q-wave myocardial infarction (1.2% vs 0.2%), and target vessel revascularization (10.7% vs 7.5%).
- Stent thrombosis was also higher in African-Americans (2.5% vs 0.7%).
- After multivariable analysis and adjustment for socioeconomic status, African-American race was not a significant predictor of MACE.
Conclusions:
- In this patient cohort undergoing PCI with drug-eluting stents, traditional risk factors and socioeconomic status fully accounted for the observed disparities in 1-year adverse cardiac events between African-American and non-African-American patients.
- The findings suggest that addressing socioeconomic determinants may be crucial in mitigating cardiac outcome disparities.
- Race itself was not an independent predictor of outcomes when socioeconomic factors were controlled.
Abstract:
Previous research has documented that African-Americans compared with non-African-Americans have higher rates of adverse cardiac outcomes and are less likely to be referred for an invasive cardiac procedure. These differences persist even after controlling for co-morbidities and socioeconomic status. We sought to compare 1-year outcomes between African-American and non-African-American patients in a clinical registry of patients after percutaneous coronary intervention receiving drug-eluting stents. We compared 1,221 African-American patients with 4,335 non-African-American patients referred for percutaneous coronary intervention. Patients were followed for 1 year with regard to major adverse cardiac events, including death, Q-wave myocardial infarction, and target vessel revascularization. We performed multivariable Cox proportional hazards regression to adjust for confounding variables, including median household income by zip code, to assess the contribution of African-American race to 1-year outcomes. At 1 year, African-American patients had significantly higher rates of overall major adverse cardiac events (17.7% African-American vs 12.4% non-African-American, p <0.001) and each component of death (7.8% African-American vs 5.4% non-African-American, p = 0.001), Q-wave myocardial infarction (1.2% African-American vs 0.2% non-African-American, p <0.001), and target vessel revascularization (10.7% African-American vs 7.5% non-African-American, p <0.001). Stent thrombosis was also higher in the African-American population at 1 year (2.5% African-American vs 0.7% non-African-American, p <0.001). After multivariable analysis and adjustment for socioeconomic status, however, African-American race was not a significant predictor of major adverse cardiac events. In conclusion, in this referral population, traditional risk factors and socioeconomic status accounted for the disparity between African-American and non-African-American patients.
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