Racial disparities in outcomes following percutaneous coronary intervention with drug-eluting stents.
Previous research has documented that African-Americans compared with non-African-Americans have higher rates of adverse cardiac outcomes and are less likely to be referred for an invasive cardiac procedure. These differences persist even after controlling for co-morbidities and socioeconomic status. We sought to compare 1-year outcomes between African-American and non-African-American patients in a clinical registry of patients after percutaneous coronary intervention receiving drug-eluting stents. We compared 1,221 African-American patients with 4,335 non-African-American patients referred for percutaneous coronary intervention. Patients were followed for 1 year with regard to major adverse cardiac events, including death, Q-wave myocardial infarction, and target vessel revascularization. We performed multivariable Cox proportional hazards regression to adjust for confounding variables, including median household income by zip code, to assess the contribution of African-American race to 1-year outcomes. At 1 year, African-American patients had significantly higher rates of overall major adverse cardiac events (17.7% African-American vs 12.4% non-African-American, p <0.001) and each component of death (7.8% African-American vs 5.4% non-African-American, p = 0.001), Q-wave myocardial infarction (1.2% African-American vs 0.2% non-African-American, p <0.001), and target vessel revascularization (10.7% African-American vs 7.5% non-African-American, p <0.001). Stent thrombosis was also higher in the African-American population at 1 year (2.5% African-American vs 0.7% non-African-American, p <0.001). After multivariable analysis and adjustment for socioeconomic status, however, African-American race was not a significant predictor of major adverse cardiac events. In conclusion, in this referral population, traditional risk factors and socioeconomic status accounted for the disparity between African-American and non-African-American patients.
Gaglia
Michael A
MA
Washington Hospital Center, Washington, DC, USA.
Steinberg
Daniel H
DH
Pinto Slottow
Tina L
TL
Roy
Probal K
PK
Bonello
Laurent
L
Delabriolle
Axel
A
Lemesle
Gilles
G
Okabe
Teruo
T
Torguson
Rebecca
R
Kaneshige
Kimberly
K
Xue
Zhenyi
Z
Suddath
William O
WO
Kent
Kenneth M
KM
Satler
Lowell F
LF
Pichard
Augusto D
AD
Lindsay
Joseph
J
Waksman
Ron
R
D001741:Black or African American; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004219:District of Columbia; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000208:ethnology* / Q000473:pathology / Q000628:therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class; D016019:Survival Analysis; D016896:Treatment Outcome