Racial and ethnic disparities in percutaneous coronary intervention: contemporary evidence and pathways to equity

Racial and ethnic disparities in percutaneous coronary intervention (PCI) persist despite major advances in contemporary acute coronary syndrome (ACS) care and represent an important challenge in achieving equitable cardiovascular outcomes. In this State-of-the-Art Review, we propose a PCI care-continuum framework demonstrating how inequities emerge sequentially across multiple stages of care; including baseline cardiovascular risk, prehospital triage, invasive coronary angiography, PCI decision-making, procedural optimization, and post-procedural outcomes. Contemporary evidence from randomized trials, large PCI registries, administrative datasets, and systems-of-care analyses demonstrate that Black, Hispanic, and certain Asian populations experience higher cardiometabolic burden, delayed presentation, reduced access to invasive management, and persistent disparities in clinical outcomes compared with White populations. These inequities are further amplified by structural determinants including residential segregation, unequal distribution of PCI-capable facilities, insurance-related barriers, and variation in healthcare delivery processes. Addressing these disparities requires coordinated multi-level interventions focused on standardized prehospital pathways, equitable access to invasive care, reduction of structural barriers, and implementation of equity-focused quality metrics. Improving PCI equity will require health systems to move beyond procedural excellence alone and address disparities across the entire cardiovascular care pathway.