Racial difference in cardiovascular outcomes following percutaneous coronary intervention in a public health service patient population.
BACKGROUND
Prior studies have reported conflicting findings regarding racial disparities in long-term cardiovascular outcomes after percutaneous coronary intervention (PCI). Our aim was to compare major adverse cardiac events (MACE) following PCI in black versus non-black patients in a Public Health Service (PHS) setting.


METHODS
A cohort of 1,438 consecutive patients undergoing intended PCI at a large public teaching hospital between April 2002 and September 2006 were followed for the development of MACE, defined as a composite of death, myocardial infarction (MI) and urgent target vessel revascularization.


RESULTS
The study population consisted of 47.4% blacks, 21.3% whites, 15.2% Hispanics and 16.1% Asians. Overall, 17.4% of patients developed MACE over the mean followup period of 2.9 years. The rate of MACE was significantly higher in blacks compared with non-blacks (21.7% vs. 13.6%, log-rank p < 0.001). After adjusting for age, gender, cardiovascular risk factors, socioeconomic status (SES) and potential confounding factors, black race remained a strong and independent predictor of MACE (adjusted HR, 1.52; CI, 1.18-1.96; p = 0.001). Blacks had higher rates of death (12.3% vs. 5.2%, log-rank p < 0.001) and MI (8.7% vs. 4.4%, log rank p = 0.002). There were no racial differences in in-hospital mortality and 3-month and 6-month MACE.


CONCLUSIONS
In this PHS population, blacks were found to have worse long-term cardiovascular outcomes and mortality following PCI, irrespective of differences in baseline cardiovascular risk factors, SES and health-care access.
Napan
Sirikarn
S
Division of Cardiology, Department of Medicine, John H Stroger, Jr Hospital of Cook County, Chicago, Illinois, USA. snapan@howard.edu
Kashinath
Ramesh
R
Orig
Maria
M
Kadri
Sameer
S
Khadra
Suhail
S
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001213:Asian / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data*; D002423:Cause of Death; D002641:Chicago; D001026:Coronary Artery Bypass / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000208:ethnology*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D015607:Stents; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American