Racial Disparities in Clinical Characteristics and Outcomes of Women Undergoing Percutaneous Coronary Intervention
Micaela Iantorno1, Toby Rogers2, Rebecca Torguson1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Insights
Black women experienced higher rates of major adverse cardiovascular events after percutaneous coronary intervention (PCI). This study highlights racial disparities in cardiovascular outcomes, particularly stent thrombosis, in women undergoing PCI.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Disparities Research
Background:
- Women, particularly Black women, are underrepresented in cardiovascular studies and face higher mortality risks from ischemic heart disease.
- Limited data exists comparing outcomes for Black versus white women after percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate racial disparities in 1-year major adverse cardiovascular events (MACE) among women undergoing PCI.
- To compare outcomes between Black and white women after PCI.
Main Methods:
- Retrospective analysis of 4776 female patients (1916 Black, 2860 white) who underwent PCI between 2003 and 2016.
- Endpoints included MACE, death, myocardial infarction, target vessel revascularization (TVR), and stent thrombosis (ST) at 30 days and 1 year.
- Proportional Cox hazard models were used to assess outcomes after adjusting for confounding factors.
Main Results:
- Black women presented younger with higher risk factor prevalence but had similar periprocedural/in-hospital outcomes.
- Rates of myocardial infarction, TVR, and ST were significantly higher in Black women at 30 days and 1 year.
- After adjustment, only stent thrombosis (ST) remained significantly higher in Black women compared to white women.
Conclusions:
- Racial disparities exist in baseline characteristics and outcomes for women undergoing PCI, with Black women presenting later and experiencing higher rates of ST.
- Interventions for early diagnosis and improved prevention are needed for Black women.
- Further research should identify factors contributing to cardiovascular outcomes in women post-PCI.
Background/Purpose:
Women are underrepresented in cardiovascular clinical studies. Black women have a higher ischemic heart disease mortality risk than their white counterparts. However, there exist limited outcome data comparing black women and white women after percutaneous coronary intervention (PCI). The aim of this retrospective analysis was to evaluate for racial disparities in 1-year major adverse cardiovascular events (MACE) in women undergoing PCI.
Methods/Materials:
Within our PCI database, we identified 4776 female patients who underwent PCI between 2003 and 2016. Of those, 1916 were black and 2860 were white. Endpoints included MACE, death, myocardial infarction, target vessel revascularization (TVR) and stent thrombosis (ST) at 30 days and 1 year. A proportional Cox hazard model analysis was performed to assess outcomes after adjustment for confounding factors.
Results:
Black women presented at a younger age and had a significantly higher prevalence of risk factors. Periprocedural and in-hospital outcomes were similar in the 2 groups. At 30 days and 1 year, the rates of myocardial infarction, TVR and ST were significantly higher in black women. After adjustment for baseline differences, only ST appears to be more likely to occur in black women than in white women.
Conclusions:
In this large cohort of women with coronary artery disease undergoing PCI, we observed racial disparities primarily in baseline characteristics indicative of need for interventions to achieve early diagnosis and better prevention in black women. Future directions should include efforts to identify and better characterize the factors underlying and contributing to cardiovascular outcomes in women after PCI.
Summary:
In this real-world analysis from a large cohort of women with coronary artery disease undergoing percutaneous coronary intervention at a US tertiary-care center, racial disparities were observed, especially in baseline characteristics, indicating late presentation.
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