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Published on: March 26, 2018
The racial disparity among post transcatheter aortic valve replacement outcomes: A meta-analysis
Vikash Jaiswal1,2, Song Peng Ang3, Muhammad Hanif4
1JCCR Cardiology, Varanasi, India.
Insights
Racial disparities in Transcatheter Aortic Valve Replacement (TAVR) outcomes exist. Black patients face higher risks of myocardial infarction (MI) and acute kidney injury (AKI) post-TAVR compared to white patients.
Area of Science:
- Cardiovascular Medicine
- Health Disparities Research
- Interventional Cardiology
Background:
- Racial disparities are documented in cardiovascular disease, but their impact on Transcatheter Aortic Valve Replacement (TAVR) outcomes is not well understood.
- Existing research highlights general cardiovascular disease disparities, yet specific data on post-TAVR racial differences in outcomes is lacking.
Purpose of the Study:
- To investigate and evaluate racial disparities in outcomes among Black and White patients following TAVR.
- To compare the incidence of adverse events between different racial groups undergoing TAVR.
Main Methods:
- A systematic literature search was conducted across electronic databases up to September 26, 2022.
- In-hospital all-cause mortality, myocardial infarction (MI), acute kidney injury (AKI), permanent pacemaker implantation (PPI) or ICD, stroke, vascular complications, and major bleeding were analyzed as primary and secondary outcomes.
Main Results:
- Analysis of three studies involving 102,009 patients revealed comparable in-hospital mortality, stroke, major bleeding, and vascular complication rates between Black and White patients.
- White patients demonstrated lower odds of MI (OR, 0.65) and AKI (OR, 0.84) compared to Black patients.
- Conversely, White patients had higher odds of permanent pacemaker implantation (PPI) or ICD (OR, 1.16) than Black patients.
Conclusions:
- Significant racial disparities exist in post-TAVR outcomes, with Black patients experiencing a higher risk of MI and AKI.
- These findings underscore the need to address identified disparities through improved guidelines, medical infrastructure, and treatment options for TAVR patients.
- Further research and policy development are crucial to mitigate these adverse outcomes and promote equitable care.
Background:
Racial disparities have been well described in cardiovascular disease. However, the impact of race on the outcomes post - Transcatheter aortic valve replacement (TAVR) remains unknown.
Objective:
We aim to evaluate the disparity among the race (black and white) post - TAVR.
Methods:
We systematically searched all electronic databases from inception until September 26, 2022. The primary outcome was in-hospital all-cause mortality, and secondary outcomes was myocardial infarction (MI), acute kidney injury (AKI), permanent pacemaker implantation (PPI) or ICD, stroke, vascular complications, and major bleeding.
Results:
A total of three studies with 1,02,009 patients were included in the final analysis. The mean age of patients with white and black patients was 82.65 and 80.45 years, respectively. The likelihood of in-hospital all-cause mortality (OR, 1.01(95 %CI: 0.86-1.19), P = 0.93), stroke (OR, 0.83(95 %CI:0.61-1.13), P = 0.23, I2 = 46.57 %], major bleeding [OR, 1.05(95 %CI:0.92-1.20), P = 0.46), and vascular complications [OR, 0.92(95 %CI:0.81-1.06), P = 0.26), was comparable between white and black patients. However, patients with white race have lower odds of MI (OR, 0.65(95 %CI:0.50-0.84), P < 0.001), and AKI (OR, 0.84(95 %CI:0.74-0.95), P = 0.01) and higher odds of PPI or ICD (OR, 1.16(95 %CI: 1.06-1.27), P < 0.001, I2 = 0 %) compared with black race patients.
Conclusion:
Our findings suggest disparity post - TAVR outcomes existed, and black patients are at higher risk of MI and AKI than white patients.Key Clinical Message:•What is already known on this topic: Disparity has been witnessed among patients with cardiovascular disease. However, no studies have drawn a significant association among post-TAVR patients' outcomes•What this study adds: Among patients who underwent TAVR, there is a difference in the adverse outcomes between black and white race patients. White patients have a lower risk of post-procedure MI and AKI compared with Black patients.•How this study might affect research, practice, or policy: These disparities need to be addressed, and proper guidelines need to be made along with engaging patients with better medical infrastructure and treatment options..
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