title: Racial/Ethnic variation in carotid artery revascularization utilization and outcomes: analysis from the National Cardiovascular Data Registry.
abstract: OBJECTIVE
  It is not known whether racial or ethnic disparities observed with other revascularization procedures are also seen with carotid artery stenting (CAS) and endarterectomy (CEA).
  
  
  METHODS
  We compared the utilization and outcomes of CAS and CEA across racial/ethnic groups within the CARE Registry between May 2007 and December 2012.
  
  
  RESULTS
  Between 2007 and 2012, of the 13 129 patients who underwent CAS, majority were non-Hispanic whites (89.3%), followed by blacks (4.4%), Hispanics (4.3%), and other groups (2.0%). A similar distribution was observed among the 10 953 patients undergoing CEA (non-Hispanic whites, 92.6%; blacks, 3.5%; Hispanics, 2.8%; and other groups, 1.1%). During this time period, a trend toward proportionate increase in CAS utilization was observed in non-Hispanic whites and other groups, whereas the opposite was observed among Hispanics and blacks. This trend persisted even when hospitals performing both CAS and CEA were exclusively analyzed. Adherence to antiplatelet and statin therapy was significantly lower among blacks post CEA. In-hospital major adverse cardiac and cerebrovascular events remained comparable across groups post CAS and CEA. At 30 days, the incidence of stroke (7.2%) and major adverse cardiac and cerebrovascular events (8.8%) was higher among blacks post CEA (P<0.05), after risk adjustment.
  
  
  CONCLUSIONS
  During the study period, utilization of CAS and CEA was highest among non-Hispanic whites. There was a trend toward increased CAS utilization over time among non-Hispanic whites and other groups, and a trend toward increased CEA utilization among Hispanics and blacks. In-hospital major adverse cardiac and cerebrovascular events remained comparable between groups, whereas 30-day major adverse cardiac and cerebrovascular events were significantly higher in blacks.
authors.affiliation: From the Cleveland Clinic Foundation, OH (S.A.W.); Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, MO (K.F.K.); Michigan Heart and Vascular Institute, Ypsilanti (H.D.A.); Holy Name Medical Center, Teaneck, NJ (J.R.); University of Oklahoma Health Sciences Center and Veterans' Affairs Medical Center (A.T., B.P., C.A.S., F.L.); and Massachusetts General Hospital, Boston (D.D.).
authors.forename: Siddharth A
authors.initials: SA
authors.lastname: Wayangankar
authors.affiliation: From the Cleveland Clinic Foundation, OH (S.A.W.); Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, MO (K.F.K.); Michigan Heart and Vascular Institute, Ypsilanti (H.D.A.); Holy Name Medical Center, Teaneck, NJ (J.R.); University of Oklahoma Health Sciences Center and Veterans' Affairs Medical Center (A.T., B.P., C.A.S., F.L.); and Massachusetts General Hospital, Boston (D.D.).
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Kennedy
authors.affiliation: From the Cleveland Clinic Foundation, OH (S.A.W.); Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, MO (K.F.K.); Michigan Heart and Vascular Institute, Ypsilanti (H.D.A.); Holy Name Medical Center, Teaneck, NJ (J.R.); University of Oklahoma Health Sciences Center and Veterans' Affairs Medical Center (A.T., B.P., C.A.S., F.L.); and Massachusetts General Hospital, Boston (D.D.).
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.affiliation: From the Cleveland Clinic Foundation, OH (S.A.W.); Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, MO (K.F.K.); Michigan Heart and Vascular Institute, Ypsilanti (H.D.A.); Holy Name Medical Center, Teaneck, NJ (J.R.); University of Oklahoma Health Sciences Center and Veterans' Affairs Medical Center (A.T., B.P., C.A.S., F.L.); and Massachusetts General Hospital, Boston (D.D.).
authors.forename: John
authors.initials: J
authors.lastname: Rundback
authors.affiliation: From the Cleveland Clinic Foundation, OH (S.A.W.); Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, MO (K.F.K.); Michigan Heart and Vascular Institute, Ypsilanti (H.D.A.); Holy Name Medical Center, Teaneck, NJ (J.R.); University of Oklahoma Health Sciences Center and Veterans' Affairs Medical Center (A.T., B.P., C.A.S., F.L.); and Massachusetts General Hospital, Boston (D.D.).
authors.forename: Alfonso
authors.initials: A
authors.lastname: Tafur
authors.affiliation: From the Cleveland Clinic Foundation, OH (S.A.W.); Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, MO (K.F.K.); Michigan Heart and Vascular Institute, Ypsilanti (H.D.A.); Holy Name Medical Center, Teaneck, NJ (J.R.); University of Oklahoma Health Sciences Center and Veterans' Affairs Medical Center (A.T., B.P., C.A.S., F.L.); and Massachusetts General Hospital, Boston (D.D.).
authors.forename: Douglas
authors.initials: D
authors.lastname: Drachman
authors.affiliation: From the Cleveland Clinic Foundation, OH (S.A.W.); Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, MO (K.F.K.); Michigan Heart and Vascular Institute, Ypsilanti (H.D.A.); Holy Name Medical Center, Teaneck, NJ (J.R.); University of Oklahoma Health Sciences Center and Veterans' Affairs Medical Center (A.T., B.P., C.A.S., F.L.); and Massachusetts General Hospital, Boston (D.D.).
authors.forename: Bhavin
authors.initials: B
authors.lastname: Patel
authors.affiliation: From the Cleveland Clinic Foundation, OH (S.A.W.); Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, MO (K.F.K.); Michigan Heart and Vascular Institute, Ypsilanti (H.D.A.); Holy Name Medical Center, Teaneck, NJ (J.R.); University of Oklahoma Health Sciences Center and Veterans' Affairs Medical Center (A.T., B.P., C.A.S., F.L.); and Massachusetts General Hospital, Boston (D.D.).
authors.forename: Chittur A
authors.initials: CA
authors.lastname: Sivaram
authors.affiliation: From the Cleveland Clinic Foundation, OH (S.A.W.); Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, MO (K.F.K.); Michigan Heart and Vascular Institute, Ypsilanti (H.D.A.); Holy Name Medical Center, Teaneck, NJ (J.R.); University of Oklahoma Health Sciences Center and Veterans' Affairs Medical Center (A.T., B.P., C.A.S., F.L.); and Massachusetts General Hospital, Boston (D.D.). faisal-latif@ouhsc.edu.
authors.forename: Faisal
authors.initials: F
authors.lastname: Latif
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002548:Cerebral Revascularization / Q000009:adverse effects*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology; D006630:Hispanic or Latino; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012042:Registries; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology; D014481:United States; D044465:White People
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors
keywords: endarterectomy, carotid; stroke