Effect of Race and Ethnicity on Outcomes With Drug-Eluting and Bare Metal Stents: Results in 423 965 Patients in the Linked National Cardiovascular Data Registry and Centers for Medicare & Medicaid Services Payer Databases

May 21, 2013
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Authors:
Kumar RS, Douglas PS, Peterson ED, et al.
Citation:
Circulation 2013;127:1395-1403.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the impact of race on the safety and effectiveness of drug-eluting stents (DES)?

Methods:

The authors examined outcomes of 423,965 patients in the National Cardiovascular Data Registry (NCDR) CathPCI Registry database linked to Medicare claims for follow-up. The authors examined trends in DES use, 30-month outcomes, and relative outcomes of DES versus bare-metal stents (BMS) in each racial group.

Results:

The study cohort was comprised of 390,351 white, 20,191 black, 9,342 Hispanic, and 4,171 Asian patients who underwent percutaneous coronary intervention (PCI) between 2004 to 2008, at 940 sites. Trends in adoption of DES were similar across all groups. Relative to whites, black and Hispanic patients undergoing PCI had higher long-term risks of death and myocardial infarction (blacks: hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.24-1.32; Hispanics: HR, 1.15; 95% CI, 1.10-1.21). Long-term outcomes were similar in Asians and whites (HR, 0.99; 95% CI, 0.92-1.08). The use of DES was associated with better 30-month survival and lower myocardial infarction rates compared with the use of BMS among all groups except Hispanics, who had similar outcomes with DES or BMS.

Conclusions:

The authors concluded that black and Hispanic patients undergoing PCI had worse long-term outcomes compared with white and Asian patients.

Perspective:

This study adds to prior data demonstrating poor long-term outcomes in the minority population. The impact of race on cardiovascular outcome is complex and is strongly influenced by socioeconomic factors. Further research is needed to understand the mechanistic underpinnings of this association, and to define strategies to rectify this.

Keywords: Myocardial Infarction, Follow-Up Studies, Coronary Restenosis, Drug-Eluting Stents, Medicaid, European Continental Ancestry Group, Sirolimus, Hispanic Americans, Angioplasty, Balloon, Coronary, Percutaneous Coronary Intervention, Stents, Minority Groups, Registries, Confidence Intervals, Medicare, African Continental Ancestry Group, United States


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