TCT: Being black is independent predictor of post-PCI adverse events

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SAN FRANSISCO—Blacks were found to have worse long-term cardiovascular outcomes and mortality, following PCI, irrespective of differences in baseline cardiovascular risk factors, socioeconomic status and healthcare access, based on a study presentation Tuesday at the annual Transcatheter Cardiovascular Therapeutics meeting.

Sirikarn Napan, MD, from Hospital of Cook County in Chicago, presented the findings of the Public Health Service (PHS) population. According to the researchers, prior studies have reported “conflicting findings” regarding racial disparities in long-term outcomes after PCI. The researchers sought to compare major adverse cardiac events (MACE) following PCI in black versus non-black patients in PHS setting.

Also, Napan said that no previous study has adjusted for socioeconomic considerations, which was determined through the zip code assessments. In the trial, African-Americans had a lower socioeconomic status, compared with the non-black cohort.

They followed a cohort of 1,438 consecutive patients undergoing intended PCI at a large, public teaching hospital between April 2002 and September 2006 for the development of MACE, which the investigators defined as a composite of death, MI and urgent target vessel revascularization.

Napan explained that the study population consisted of 47.4 percent blacks, 21.3 percent whites, 15.2 percent Hispanics and 16.1 percent Asians. For the purpose of the study, the researchers split the participants into two groups (47.4 percent blacks and 52.6 percent non-blacks). The secondary endpoint was in-hospital death and MI.

Hypertension, body mass index, cigarette smoking was higher among the black population. Also, the systolic blood pressure was higher among blacks (145 vs. 137).

Napan noted that there were few differences in pharmaceutical and procedural treatment between the two arms. Interestingly, blacks were more likely to undergo PCI than non-blacks.

Overall, the researchers found that 17.4 percent of patients developed MACE over the mean follow up of three years. “The rate of MACE was significantly higher in blacks compared with non-blacks [21.7 vs. 13.6 percent],” Napan said. Also, blacks had higher rates of death (12.3 vs. 5.2 percent) and MI (8.7 vs. 4.4 percent).

Interestingly, there were no racial differences in three-month and six-month MACE; however, things began to trend negative for blacks at one year.

After adjusting for age, gender, cardiovascular risk factors, socioeconomic status and other confounding factors, the “black race remained a strong and independent predictor of MACE,” Napan said.

He reported that there were no significant differences for secondary endpoints, until one year.

The researchers had incomplete data on the compliance in these patient populations, which Napan listed as a limitation of their trial. He stressed that this might be the “major issue” with black patients, and an area for clinicians to improve upon in their practices.

“Further studies remain needed to explore the racial disparity in post-PCI surveillance and treatment compliance potentially responsible for the worse outcomes among blacks compared to other races,” Napan concluded.