Racial and Ethnic Differences in Transcatheter Coarctation Repair among Adolescents and Adults

Racial and ethnic (RAE) differences in the presentation and outcomes of coarctation of the aorta (CoA) among adolescents and adults undergoing transcatheter coarctation repair (TCR) remain poorly defined. We retrospectively analyzed patients aged ≥16 years who underwent TCR at US centers participating in the NCDR IMPACT® registry between 2011 and 2023. Among 2267 patients, 70.9% were Non-Hispanic White (NHW), 18.5% Hispanic (H), 7.4% Non-Hispanic Black (NHB), and 3.3% Non-Hispanic Other (NHO), demonstrating underrepresentation of Hispanic and NHB patients. Late CoA presentation occurred in 53.6% of patients and did not differ across RAE groups (p=0.076). Older age was the only independent predictor of late presentation (OR 1.25, 95% CI 1.13-1.40; p<0.001). Late presentation was more frequent in adult-based than pediatric-based hospitals (60.1% vs. 48.6%, p<0.001) but was not associated with center procedural volume. Adverse TCR outcomes occurred in 8.8% of patients and were similar across RAE groups (p=0.392). Higher median household income was independently associated with lower odds of adverse outcomes (OR 0.78, 95% CI 0.62-0.97; p=0.027), while outcomes did not differ by hospital type, TCR volume, or ACHA accreditation status. Sensitivity analyses comparing NHW versus non-NHW patients showed no significant differences in presentation or procedural outcomes, although in-hospital mortality was higher among non-NHW patients (0.6% vs. 0.1%, p=0.012). In conclusion, in this large contemporary registry, RAE was not associated with late presentation or adverse TCR outcomes. Although Hispanic, NHB and NHO patients were underrepresented, TCR was associated with favorable outcomes across groups, supporting its safety and effectiveness while highlighting the need for improved CoA detection and equitable access to specialized congenital heart disease care.