title: Better survival for African and Hispanic/Latino Americans after infrainguinal revascularization in the Society for Vascular Surgery Vascular Quality Initiative.
abstract: Inferior survival outcomes have historically been reported for African Americans with cardiovascular disease, and poorer outcomes have been presumed for peripheral arterial disease (PAD) as well. The current study evaluates the effect of race and ethnicity on survival of patients undergoing open or endovascular interventions for lower extremity PAD.
  
  
  
  Data of patients from the Society for Vascular Surgery Vascular Quality Initiative database were obtained for patients undergoing open infrainguinal (INFRA) or suprainguinal (SUPRA) bypass, peripheral vascular intervention (PVI), and amputation (AMP). Patients were further stratified as suprainguinal (SupraPVI) if any of the first three interventions listed included the aorta or iliac vessels or infrainguinal (InfraPVI) if not. The primary outcome was the patient's death (overall mortality) as recorded in the database or determined by cross-reference with the Social Security Death Index (SSDI). The secondary outcome consisted of perioperative mortality during the index hospitalization. Generalized linear modeling provided multivariate analysis, with entry of variables dependent on results of univariate analysis.
  
  
  
  From January 2003 through September 2015, a total of 24,241 INFRA bypass, 8028 SUPRA bypass, 48,048 InfraPVI, 21,196 SupraPVI, and 3423 AMP patients met criteria for analysis, with a median follow-up of 18 (interquartile range, 8-33) months. Combining all procedures, overall mortality was lower among African Americans than among white Americans (12.4% vs 14.2%; P < .0001) but not death in the periprocedural period (1.1% vs 1.2%; P = .26). To account for differences in length of follow-up, Cox proportional hazards analysis confirmed that the African American race was independently associated with a significantly lower occurrence of overall mortality after INFRA bypass (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.70-0.88; P < .0009), InfraPVI (HR, 0.72; 95% CI, 0.67-0.78; P < .0001), and SupraPVI (HR, 0.77; 95% CI, 0.66-0.90; P = .0009) interventions but not after SUPRA bypass or AMP. Similarly, by Cox proportional hazards, Hispanic/Latino ethnicity was also independently associated with lower overall mortality after INFRA bypass (HR, 0.75; 95% CI, 0.62-0.91; P = .0030), InfraPVI (HR, 0.69; 95% CI, 0.62-0.78; P < .0001), and SupraPVI (HR, 0.68; 95% CI, 0.52-0.89; P = .0045) but not after SUPRA bypass or AMP.
  
  
  
  Contrary to the published data for other forms of cardiovascular disease, African American patients as well as patients identified with Hispanic/Latino ethnicity with PAD included in the Society for Vascular Surgery Vascular Quality Initiative undergoing INFRA revascularization for lower extremity PAD experienced better overall survival compared with white Americans.
authors.affiliation: Surgical Service, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC; Division of Vascular and Endovascular Surgery, Medical University of South Carolina, Charleston, SC. Electronic address: brothete@musc.edu.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Brothers
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Jingwen
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Mauldin
authors.affiliation: The Vascular Group, PLLC, Poughkeepsie, NY.
authors.forename: Britt H
authors.initials: BH
authors.lastname: Tonnessen
authors.affiliation: Division of Vascular and Endovascular Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Robison
authors.affiliation: Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC.
authors.forename: Raghuveer
authors.initials: R
authors.lastname: Vallabhaneni
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: John W
authors.initials: JW
authors.lastname: Hallett
authors.affiliation: Department of Surgery, George Washington University, Washington, D.C.
authors.forename: Anton N
authors.initials: AN
authors.lastname: Sidawy
mesh_terms: D001741:Black or African American; D000368:Aged; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D005260:Female; D006630:Hispanic or Latino; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications / Q000208:ethnology / Q000401:mortality; D016016:Proportional Hazards Models; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards