NCDR Study Shows Variation Among Racial Groups For Revascularization Procedures

Different approaches may be taken for carotid artery revascularization among patients from different racial and ethnic backgrounds, with a trend toward carotid artery stenting (CAS) among non-Hispanic whites and other groups (Native Americans and Asians) and endarterectomy (CEA) among Hispanics and blacks, according to a study recently published in Stroke.

Using data from ACC’s CARE Registry, now the PVI Registry, researchers assessed records from 24,082 patients between May 2007 and Dec. 2012. Among these patients, 13,129 had a CAS and 10,953 had a CEA. Of those in the CAS group, 89 percent were non-Hispanic whites; 4.4 percent were black; 4.3 percent were Hispanic; and 2 percent were from other groups. Researchers observed a similar distribution among patients undergoing CEA: close to 93 percent were non-Hispanic whites; 3.5 percent were black; 2.8 percent were Hispanic; and 1 percent came from other groups. 

Results showed that patients who had undergone CAS were prescribed aspirin and clopidogrel at a rate greater than 90 percent and statins at a rate of about 80 percent, with little difference among races. After CEA, however, the rate of aspirin prescriptions was less than 90 percent, with a significantly lower rate for blacks and Hispanics. Prescription rates for statins after CEA were significantly lower for non-Hispanic whites compared with Hispanics and other groups.    

In terms of in-hospital outcomes, after adjusting for age, sex, presence of atrial fibrillation/flutter, prior CEA or CAS, neurological events before the procedure, and discharge medications, the researchers found little difference in death and myocardial infarction among different racial groups regardless of the procedure performed. Although incidence of in-hospital stroke did not differ among racial groups following CAS, the rate after CEA trended higher among blacks and other groups, but did not reach statistical significance. In addition, at 30 days, the outcomes were comparable for both procedures for all outcomes except for stroke. Among the CEA group, the incidence of stroke at 30 days was significantly higher among black patients. 

According to Siddharth A. Wayangankar, MD, the study’s lead author, “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.” He expresses concern that blacks in the CEA group had the lowest prescription rates. “[These findings,] could reflect a relative lack of implementation of performance after CEA, and indicate a need to reinforce guideline-directed therapy after CEA to ensure minimization of disparities in care,” he notes.

Clinical Topics: Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: African Americans, Aspirin, Atrial Fibrillation, Carotid Arteries, Endarterectomy, European Continental Ancestry Group, Hispanic Americans, Incidence, Indians, North American, Myocardial Infarction, Registries, Stroke, Ticlopidine, National Cardiovascular Data Registries, PVI Registry

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