Patients who are Black, compared with Hispanic or white, are at an increased risk for major adverse outcomes, including death, after undergoing PCI, according to a study published July 6 in JACC: Cardiovascular Interventions.

Mordechai Golomb, MD, et al., used pooled patient-level data from 10 prospective, randomized controlled trials of PCI, classified by race, to assess the presence of racial disparities in clinical characteristics and outcomes. The authors note the source of current raced-based PCI outcomes was registries and single-center studies, which lack central monitoring and event adjudication.

A combined total of 22,638 patients who underwent PCI were included: 20,585 (90.9%) were white (reference group), 918 (4.1%) were Black, 473 (2.1%) were Hispanic and 404 (1.8%) were Asian. Other races were excluded from the analysis due to small sample sizes. Baseline characteristics and outcomes at 30 days, one year, and five years were assessed.

The principal outcomes of interest were all-cause death, myocardial infarction (MI), and major adverse cardiac events (MACE), defined as the composite of cardiac death, MI or ischemia-driven target lesion revascularization.

The researchers found that Black and Hispanic patients had more clinical comorbidities. Furthermore, Black and Hispanic patients had worse angiographic outcomes, although they did not have higher risk angiographic features. Black and Hispanic patients, but not Asian patients, had higher unadjusted rates of adverse clinical events. After multivariate analysis, Black patients had a higher adjusted risk for adverse events, but Hispanic and Asian patients did not.

At five years, the rate of MACE was 23.9% in Black patients, 21.5% in Hispanic patients, 18.8% in white patients and 11.2% in Asian patients. An independent association was found between Black race and five-year risk for MACE on multivariate analysis.

At one year, multivariate analysis revealed that Black race was associated with an increased adjusted risk for death (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.26-3.36; p=0.004) and MI (HR, 1.45; 95% CI, 1.01-2.10; p=0.045). At five years, Black race was associated with an increased adjusted risk for MI (HR, 1.55; 95% CI, 1.15-2.09; p=0.004) and MACE (HR, 1.28; 95% CI, 1.05-1.57; p=0.01).

The authors write that "[f]urther research examining race-based outcomes after PCI is warranted to understand and mitigate these differences."

In an accompanying editorial comment, Michael G. Nanna, MD, and Eric D. Peterson, MD, MPH, FACC, write that racial health disparities require, "... widespread commitment at the community, institution, and broader legislative levels," and, "...rather than merely observe these differences over and over again for the next 30 years, there is an urgent need for action to address these, both locally and nationally."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Multivariate Analysis, Percutaneous Coronary Intervention, Prospective Studies, African Americans, Hispanic Americans, Asian Continental Ancestry Group, Myocardial Infarction

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