Racial difference in cardiovascular outcomes following percutaneous coronary intervention in a public health service
Sirikarn Napan1, Ramesh Kashinath, Maria Orig
1Division of Cardiology, Department of Medicine, John H Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA. snapan@howard.edu
Insights
Black patients experienced significantly higher rates of major adverse cardiac events (MACE) and death after percutaneous coronary intervention (PCI). These disparities persisted even after adjusting for risk factors, highlighting a critical area for cardiovascular health equity.
Area of Science:
- Cardiovascular Medicine
- Health Disparities Research
- Interventional Cardiology
Background:
- Conflicting data exists on racial disparities in long-term cardiovascular outcomes post-percutaneous coronary intervention (PCI).
- Investigating these disparities in a Public Health Service (PHS) setting is crucial for understanding population health trends.
Purpose of the Study:
- To compare major adverse cardiac events (MACE) following PCI in Black versus non-Black patients.
- To identify if race is an independent predictor of cardiovascular outcomes after PCI.
Main Methods:
- A cohort of 1,438 patients undergoing PCI between 2002 and 2006 was analyzed.
- Major adverse cardiac events (MACE) were defined as death, myocardial infarction (MI), or urgent target vessel revascularization.
- Follow-up was conducted for a mean of 2.9 years.
Main Results:
- Black patients (47.4%) had a significantly higher MACE rate (21.7%) compared to non-Black patients (13.6%).
- Black race remained an independent predictor of MACE (adjusted HR, 1.52; CI, 1.18-1.96), with higher rates of death and MI.
- No racial differences were observed in in-hospital mortality or MACE at 3 and 6 months.
Conclusions:
- Black individuals experienced worse long-term cardiovascular outcomes and mortality after PCI in this PHS population.
- These disparities were evident irrespective of baseline cardiovascular risk factors, socioeconomic status, or healthcare access.
- Findings underscore the need for targeted interventions to address racial inequities in cardiovascular care post-PCI.
Background:
Prior studies have reported conflicting findings regarding racial disparities in long-term cardiovascular outcomes after percutaneous coronary intervention (PCI). Our aim was to compare major adverse cardiac events (MACE) following PCI in black versus non-black patients in a Public Health Service (PHS) setting.
Methods:
A cohort of 1,438 consecutive patients undergoing intended PCI at a large public teaching hospital between April 2002 and September 2006 were followed for the development of MACE, defined as a composite of death, myocardial infarction (MI) and urgent target vessel revascularization.
Results:
The study population consisted of 47.4% blacks, 21.3% whites, 15.2% Hispanics and 16.1% Asians. Overall, 17.4% of patients developed MACE over the mean followup period of 2.9 years. The rate of MACE was significantly higher in blacks compared with non-blacks (21.7% vs. 13.6%, log-rank p < 0.001). After adjusting for age, gender, cardiovascular risk factors, socioeconomic status (SES) and potential confounding factors, black race remained a strong and independent predictor of MACE (adjusted HR, 1.52; CI, 1.18-1.96; p = 0.001). Blacks had higher rates of death (12.3% vs. 5.2%, log-rank p < 0.001) and MI (8.7% vs. 4.4%, log rank p = 0.002). There were no racial differences in in-hospital mortality and 3-month and 6-month MACE.
Conclusions:
In this PHS population, blacks were found to have worse long-term cardiovascular outcomes and mortality following PCI, irrespective of differences in baseline cardiovascular risk factors, SES and health-care access.
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