Adverse PCI outcomes most common among Black patients

Adverse outcomes, including death, are more common for Black patients who undergo percutaneous coronary intervention (PCI) than they are for white patients, according to new findings published in JACC: Cardiovascular Interventions.

The authors tracked data from more than 22,000 PCI patients who participated in one of 10 randomized trials. While 90.9% of patients in the study were white, 4.1% were Black, 1.8% were Asian and another 2.1% were Hispanic. Other races were excluded from the study due to small sample sizes.

Overall, the rates of major adverse cardiac events (MACE) after five years were 23.9% for Black patients, 21.5% for Hispanic patients, 18.8% for white patients and 11.2% for Asian patients. Researchers confirmed an independent association between being Black and having a higher MACE risk after five years.

What, exactly, leads to this association? The authors provided several potential explanations.

“The variables that may contribute to the greater cardiovascular risks in minorities are multifactorial,” senior author Gregg W. Stone, MD, a professor of cardiology at the Icahn School of Medicine at Mount Sinai in New York City, said in a prepared statement from the American College of Cardiology. “The variables include risk factors (e.g., greater hypertension, smoking and diabetes, and differences in body mass index), differences in cardiac structure (e.g., coronary artery size and left ventricular mass) and socioeconomic considerations (e.g., reduced access to care and/or insurance coverage, lack of preventative care, disease awareness and education, delayed presentation when ill, and in some studies varying provision of care).” 

Stone also emphasized that there is potential to improve such racial disparities—but it will take a lot of time, energy and focus from a wide variety of stakeholders.  

“I am inherently optimistic, and I am hopeful that the increased societal attention to racial disparities prompted by recent social injustices will translate to improve health care and outcomes for minorities,” he said “But it won't just happen without active concerted efforts to promote change and opportunity, a task for government, regulators, payors, hospital administrators, physicians and all health care providers.”

The researchers did note that their study had certain limitations. The sample sizes for Black and Hispanic patients, for example, were quite small. In addition, they noted, “our dataset does not include information on time to invasive therapy or medical treatment assignment and compliance, nor can it entirely adjust for uncaptured socioeconomic factors.”

The full JACC: Cardiovascular Interventions study is available here.