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Impact of race on infrainguinal angioplasty and stenting
Terry J Chong1, Vincent L Rowe, Fred A Weaver
1Division of Vascular Surgery, University of Southern California, Los Angeles, CA, USA. terry.chong@surgery.usc.edu
Insights
Racial background does not impact lower extremity endovascular intervention outcomes. However, angioplasty alone showed varied failure rates by race, which disappeared when stents were used.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Health Disparities
Background:
- Catheter-based interventions for lower extremity arteries are increasingly common.
- The influence of race on outcomes of endovascular interventions for peripheral arterial disease remains unclear.
Purpose of the Study:
- To investigate the effect of patient race on the durability of angioplasty and stenting in the superficial femoral and popliteal arteries.
Main Methods:
- Retrospective review of 374 percutaneous interventions in 280 patients over 14 years (1994-2007).
- Analysis of outcomes by race, including Kaplan-Meier survival curves and Cox regression.
- Data collected on intervention indication, lesion classification (TransAtlantic InterSociety Consensus II), runoff, and stent placement.
Main Results:
- No significant difference in primary patency rates was observed between different racial groups for overall procedures.
- In angioplasty-only procedures, Caucasians had the highest failure rate, while Asians had the lowest (p < 0.002).
- This racial difference in failure rates was not observed in patients receiving angioplasty with stenting.
Conclusions:
- Race does not appear to be a significant factor in the long-term durability of superficial femoral and popliteal artery interventions.
- While angioplasty alone showed racial disparities in failure rates, the use of stents mitigated these differences.
- Factors like dyslipidemia and complex lesions (TransAtlantic InterSociety Consensus II C/D) negatively impacted primary patency.
Background:
Over the last decade, catheter-based interventions on lower extremity arteries have been used with increasing frequency. However, the effect of racial background on the outcome of lower extremity endovascular interventions for peripheral arterial disease is unknown. The purpose of this study was to determine the effect of patients' race on the durability of angioplasty and stenting performed on the superficial femoral and popliteal arteries.
Methods:
The records of all patients undergoing percutaneous intervention on the lower extremity arteries during a 14-year period were reviewed. During a 44-month period (2003-2007), all patients underwent primary stenting as part of a prospective study protocol. Indication for intervention, TransAtlantic InterSociety Consensus II classification, runoff anatomy, site of intervention, and the placement of stents were noted. Results were analyzed by race. Kaplan-Meier life survival curves were plotted and differences between groups tested by log-rank method. Cox proportional hazards regression model was used to perform the multivariate analysis.
Results:
Between 1994 and 2007, a total of 374 percutaneous interventions were performed on the superficial femoral and popliteal arteries in 280 patients. Of these, 182 procedures were angioplasties and 192 included both angioplasty and stenting. The study group consisted of 60% Caucasians, 23% Hispanics, 12% African Americans, and 5% Asians. No difference in primary patency rates was noted between individuals belonging to different races. However, in those undergoing angioplasty alone, Caucasians had the highest rate of failure, followed by Hispanics, African Americans, and then Asians (p < 0.002). No difference in patency rates between races was seen in patients undergoing angioplasty with stenting. For the entire group, dyslipidemia, TransAtlantic InterSociety Consensus II C and D lesions, and angioplasty without stenting negatively affected primary patency.
Conclusions:
Race does not appear to influence the durability of catheter-based procedures performed on the superficial femoral and popliteal arteries. However, in patients who underwent angioplasty alone, it was noted that Caucasians had the highest rates of failure and Asians the lowest. However, this difference was no longer apparent when stents were used.
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