A study published in Circulation indicates that compared with white patients, black and Hispanic patients have worse outcomes following percutaneous coronary intervention (PCI). The study also found that white, Asian, and black patients all had better outcomes with drug-eluting stents compared with bare metal stents but Hispanic patients did not.
Robert Kumar, Virginia Hart, Lenox Hill Interventional Cardiac and Vascular Services, New York, USA, and others commented that data for differences in outcomes between white patients and black patients undergoing PCI are limited as previous studies have produced conflicting results (with some showing white patients to have better outcomes and others not). Also, these studies were conducted using older stent technology and the authors reported that therefore, they: “May not be applicable to patients undergoing PCI with current stent technology or to other minority populations”. Furthermore, Kumar et al commented, studies that have compared outcomes with drug-eluting stents with outcomes with bare metal stents have been “performed predominantly in white patients.” Thus, the aim of their study was to evaluate long-term outcomes with modern PCI technologies among different racial groups and compare outcomes with drug-eluting vs. bare metal stents among racial groups.
Using data from the National Cardiovascular Data Registry CathPCI Registry, the authors identified 423,965 patients (aged ≥65 years) who had undergone PCI with a drug-eluting or bare metal stent. Of these, 92.1% were white, 4.7% were black, 2.2% were Hispanic, and 1% were Asian. They found that black patients had the lowest rate of drug-eluting stent use compared with the other racial groups, and that Asian and Hispanic patients had slightly higher rates of drug-eluting stent use compared with white patients.
After adjusting outcomes for differences in baseline characteristics, Kumar et al found that, compared with white patients, black patients had a slightly higher 30-day mortality rate and also had a slightly higher rate of myocardial infarction. However, they did have slightly lower rates of repeat revascularisation. In the analysis of Hispanic patients vs. white patients, Hispanic patients had a similar mortality rate to white patients but higher rates of myocardial infarction and repeat revascularisation. Asian patients had a slightly lower mortality risk than white patients and similar rates of myocardial infarction and repeat revascularisation.
Comparing outcomes observed with drug-eluting stents vs. those with bare metal stents, the authors found that white patients, black patients, and Asian patients all had better outcomes with drug-eluting stents. However, there were no differences in outcomes between Hispanic patients who received a drug-eluting stent and those who received a bare metal stent.
According to Kumar et al, there were some variables (such as socioeconomic status) that were not measured and they may have contributed to the differences observed between racial groups. However, they added: “Physiological differences among racial and ethnic groups must also be considered as potential factors.” They added that the lack of difference between drug-eluting stents and bare metal stents observed among Hispanic patients was “hypothesis generating” and “because of retrospective nature of our analysis, we cannot further explain the observed performance of drug-eluting stents in this population.”