Black Patients Undergoing PVI Less Likely to Have Surgical or Repeat Revascularization
Black patients undergoing peripheral vascular intervention (PVI) were more likely to be younger, have comorbidities and lower socioeconomic status, and were less likely to undergo surgical or repeat PVI revascularization after the initial PVI procedure than White patients, according to a recent study published in Circulation: Cardiovascular Interventions.
Howard M. Julien, MD, MPH, FACC, et al., looked at 63,150 patients (11.8% Black, 88.2% White) from the SVS VQI Registry, formerly the NCDR PVI Registry, from April 2014 to March 2019 to investigate racial differences in presentation and outcomes of patients after peripheral arterial interventions. Researchers used the Distressed Community Index (DCI) score of patients’ zip codes to determine socioeconomic status, multivariable logistic regression to assess factors like use of drug-eluting technologies, intravascular imaging and atherectomy, and Centers for Medicare and Medicaid Services (CMS) data to evaluate rates of one-year mortality, amputations and repeat revascularizations.
Results showed that Black patients presenting for PVI, when compared with their White counterparts, were younger (67.9 vs. 70.0 years), more likely to have hypertension (94.4% vs. 89.5%) and diabetes (63.0% vs. 46.2%), less likely to be able to walk 200 meters (29.1% vs. 24.8%), and exhibited higher DCI scores (65.1 vs. 50.6). The authors also found a higher rate of drug-eluting technology use among Black patients (adjusted odds ratio [aOR], 1.14; 95% CI, 1.06-1.23) and no significant difference in the utilization of atherectomy (aOR, 0.98; 95% CI, 0.91-1.05) or intravascular imaging (aOR, 1.03; 95% CI, 0.88-1.22). Of note, Black patients had a lower rate of acute kidney injury (aOR, 0.79; 95% CI, 0.72-0.88).
Julien, et al., were able to link 7,429 patient cases to CMS data, finding that at one year post procedure Black patients were less likely to undergo surgical (adjusted hazard ratio [aHR], 0.40; 95% CI, 0.17-0.96) or repeat PVI revascularization (aHR, 0.42; 95% CI, 0.30-0.59) than White patients. No significant difference was seen for mortality (aHR, 0.8-1.4) or amputations (aHR, 2.5; 95% CI, 0.8-7.6).
“Aggressive risk factor modification, primary prevention, and access to continued cardiovascular preventive care may help narrow the gap in severity of disease at the time of presentation observed between Black and White patients in our cohort as well as influence rates of amputation in the year postprocedure,” state the authors. “It is unclear why Black patients undergo revascularization after PVI at lower rates than White patients.
Keywords: Socioeconomic Factors, Risk Factors, Registries, Atherectomy, Race Factors, Centers for Medicare and Medicaid Services, U.S., Logistic Models, Odds Ratio, United States, PVI Registry, National Cardiovascular Data Registries
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