title: Comparison of long-term safety and efficacy outcomes after drug-eluting and bare-metal stent use across racial groups: Insights from NHLBI Dynamic Registry.
abstract: BACKGROUND
  Long-term data on outcomes after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and bare-metal stent (BMS) across racial groups are limited, and minorities are under-represented in existing clinical trials. Whether DES has better long-term clinical outcomes compared to BMS across racial groups remains to be established. Accordingly, we assessed whether longer-term clinical outcomes are better with DES compared to BMS across racial groups.
  
  
  METHODS
  Using the multicenter National Heart, Lung, and Blood Institute (NHLBI)-sponsored Dynamic Registry, 2-year safety (death, MI) and efficacy (repeat revascularization) outcomes of 3326 patients who underwent PCI with DES versus BMS were evaluated.
  
  
  RESULTS
  With propensity-score adjusted analysis, the use of DES, compared to BMS, was associated with a lower risk for death or MI at 2 years for both blacks (adjusted Hazard Ratio (aHR)=0.41, 95% CI 0.25-0.69, p<0.001) and whites (aHR=0.67, 95% CI 0.51-0.90, p=0.007). DES use was associated with a significant 24% lower risk of repeat revascularization in whites (aHR=0.76, 95% CI 0.60-0.97, p=0.03) and with nominal 34% lower risk in blacks (aHR=0.66, 95% CI 0.39-1.13, p=0.13).
  
  
  CONCLUSIONS
  The use of DES in PCI was associated with better long-term safety outcomes across racial groups. Compared to BMS, DES was more effective in reducing repeat revascularization in whites and blacks, but this benefit was attenuated after statistical adjustment in blacks. These findings indicate that DES is superior to BMS in all patients regardless of race. Further studies are needed to determine long-term outcomes across racial groups with newer generation stents.
authors.affiliation: Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: olafiranyeo@upmc.edu.
authors.forename: Oladipupo
authors.initials: O
authors.lastname: Olafiranye
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Helen
authors.initials: H
authors.lastname: Vlachos
authors.affiliation: Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Suresh R
authors.initials: SR
authors.lastname: Mulukutla
authors.affiliation: Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.affiliation: Division of Cardiology, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: David O
authors.initials: DO
authors.lastname: Williams
authors.affiliation: Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Strollo
authors.affiliation: Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
authors.affiliation: Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Joon S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: A J Conrad
authors.initials: AJC
authors.lastname: Smith
mesh_terms: D000368:Aged; D044383:Black People / Q000208:ethnology*; D015331:Cohort Studies; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals / Q000009:adverse effects; D008875:Middle Aged; D054555:National Heart, Lung, and Blood Institute (U.S.) / Q000639:trends*; D062645:Percutaneous Coronary Intervention / Q000639:trends*; D044469:Racial Groups / Q000208:ethnology; D012042:Registries; D015607:Stents / Q000009:adverse effects / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology*; D001741:Black or African American
chemical_list: D008670:Metals
keywords: Coronary stents; Disparity; Long term outcomes; Race