Mortality Similar for Blacks and Whites After PCI in Veterans Affairs Study

Race was not independently associated with one-year mortality among black and white patients treated with PCI in Veterans Affairs (VA) hospitals, according to a study published July 19 in JAMA Cardiology.

Taisei Kobayashi, MD, et al., used data from the VA Clinical Assessment, Reporting and Tracking System for Cardiac Catherization Laboratories (CART-CL), which includes data from the electronic health record, along with several data sources for vital status, to compare outcomes in black and white patients who underwent PCI between October 2007 and September 2013 in 63 VA hospitals. They analyzed outcomes from January 2016 to April 2017.

For the study period of January 2016 to April 2017, they analyzed outcomes in 42,391 patients; 13.3 percent of the cohort was black. Most patients were male (98.4 percent) with a mean age of 65 years. Black patients tended to be younger, have lower socioeconomic status, and be from urban areas, and have a higher burden of comorbidities and be initially seen in the cardiac catheterization laboratory.

For the primary outcome of one-year mortality, in the unadjusted analysis, black patients compared with white patients had higher rates (7.1 percent vs. 5.9 percent; p < 0.001). They also had higher rates of the secondary outcomes of 30-day acute kidney injury (20.8 percent vs. 13.8 percent; p < 0.001), 30-day blood transfusion (3.4 percent vs. 2.7 percent; p < 0.01) and one-year readmission rates for myocardial infarction (3.3 percent vs. 2.7 percent; p = 0.01) compared with white patients.

However, in the analysis adjusted for demographics, comorbidities and procedural characteristics, there were no differences between black and white patients for one-year mortality. Except for a higher rate of adjusted 30-day acute kidney injury (odds ratio, 1.22), there was no difference in secondary outcomes between the unadjusted and adjusted analyses.

The study also found that black patients were less likely to receive a drug-eluting stent or to be prescribed beta-blockers, compared with white patients.

“This study represents the largest modern analysis to date of the influence of race on cardiovascular outcomes among U.S. veterans,” the study authors write. “A strength of the study is the ability to adjust for a wide range of confounders through the merging of clinical registry data with administrative claims.”

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Comorbidity, Drug-Eluting Stents, Veterans, Odds Ratio, Patient Readmission, European Continental Ancestry Group, African Americans, African Continental Ancestry Group, Myocardial Infarction, Electronic Health Records, Registries, Information Storage and Retrieval, Acute Kidney Injury, Demography, Blood Transfusion, Cardiac Catheterization, Social Class, Drug-Eluting Stents

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