Racial/Ethnic variation in carotid artery revascularization utilization and outcomes: analysis from the National
Siddharth A Wayangankar1, Kevin F Kennedy1, Herbert D Aronow1
1From the Cleveland Clinic Foundation, OH (S.A.W.); Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, MO (K.F.K.); Michigan Heart and Vascular Institute, Ypsilanti (H.D.A.); Holy Name Medical Center, Teaneck, NJ (J.R.); University of Oklahoma Health Sciences Center and Veterans' Affairs Medical Center (A.T., B.P., C.A.S., F.L.); and Massachusetts General Hospital, Boston (D.D.).
Insights
Racial disparities exist in carotid revascularization. While in-hospital events were similar, Black patients undergoing carotid artery stenting (CAS) or endarterectomy (CEA) had higher 30-day adverse events, indicating disparities in care.
Area of Science:
- Vascular Surgery
- Health Disparities
- Cardiovascular Outcomes
Background:
- Racial and ethnic disparities are documented in various revascularization procedures.
- It remains unclear if these disparities extend to carotid artery stenting (CAS) and carotid endarterectomy (CEA).
Purpose of the Study:
- To investigate racial and ethnic disparities in the utilization and outcomes of CAS and CEA.
- To compare procedure adoption and patient results across different racial/ethnic groups.
Main Methods:
- Analysis of the CARE Registry data from May 2007 to December 2012.
- Comparison of CAS and CEA utilization and outcomes stratified by race/ethnicity.
- Risk adjustment for 30-day outcomes.
Main Results:
- Non-Hispanic whites comprised the majority of patients undergoing both CAS (89.3%) and CEA (92.6%).
- CAS utilization increased among non-Hispanic whites and other groups, while CEA utilization increased among Hispanics and blacks.
- In-hospital adverse events were comparable; however, Black patients experienced higher 30-day stroke and major adverse cardiac and cerebrovascular events after CEA.
Conclusions:
- Significant racial/ethnic differences were observed in the utilization trends of CAS and CEA.
- While in-hospital outcomes were similar, Black patients faced higher 30-day adverse events post-CEA, suggesting persistent disparities.
Background And Purpose:
It is not known whether racial or ethnic disparities observed with other revascularization procedures are also seen with carotid artery stenting (CAS) and endarterectomy (CEA).
Methods:
We compared the utilization and outcomes of CAS and CEA across racial/ethnic groups within the CARE Registry between May 2007 and December 2012.
Results:
Between 2007 and 2012, of the 13 129 patients who underwent CAS, majority were non-Hispanic whites (89.3%), followed by blacks (4.4%), Hispanics (4.3%), and other groups (2.0%). A similar distribution was observed among the 10 953 patients undergoing CEA (non-Hispanic whites, 92.6%; blacks, 3.5%; Hispanics, 2.8%; and other groups, 1.1%). During this time period, a trend toward proportionate increase in CAS utilization was observed in non-Hispanic whites and other groups, whereas the opposite was observed among Hispanics and blacks. This trend persisted even when hospitals performing both CAS and CEA were exclusively analyzed. Adherence to antiplatelet and statin therapy was significantly lower among blacks post CEA. In-hospital major adverse cardiac and cerebrovascular events remained comparable across groups post CAS and CEA. At 30 days, the incidence of stroke (7.2%) and major adverse cardiac and cerebrovascular events (8.8%) was higher among blacks post CEA (P<0.05), after risk adjustment.
Conclusion:
During the study period, utilization of CAS and CEA was highest among non-Hispanic whites. There was a trend toward increased CAS utilization over time among non-Hispanic whites and other groups, and a trend toward increased CEA utilization among Hispanics and blacks. In-hospital major adverse cardiac and cerebrovascular events remained comparable between groups, whereas 30-day major adverse cardiac and cerebrovascular events were significantly higher in blacks.
