Fahad Alqahtani (Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, USA) and others report in Catheterization and Cardiovascular Interventions that there are no significant differences in utilisation rates, in-hospital outcomes, and cost between African American and Caucasian patients undergoing transcatheter aortic valve implantation (TAVI).
The authors write that African American race is an independent risk factor for postoperative mortality after coronary artery bypass grafting (CABG), valve replacement surgery, and heart transplantation. However they note as “African Americans represented a very small percentage of patients in the pivotal trials leading to the approval of TAVI in the USA”, data for racial disparity in TAVI “are extremely limited”. “We aimed to investigate whether a racial disparity exists in utilisation and outcomes of TAVI at a national level,” Alqahtani et al report.
Reviewing data from the nationwide inpatient sample, they identified 7,176 Caucasians (95.7%) and African American (4.3%) patients who underwent TAVI between 2011 and 2014. The ratio of TAVI/surgical valve replacement was calculated in Caucasians and African American to examine any disparities in TAVI utilisation. The authors then compared the incidence of in-hospital death, vascular complications, permanent pacemaker implantation, stroke, transient ischaemic attack, blood transfusion and acute kidney injury requiring dialysis between Caucasians and African Americans undergoing TAVI.
Results
The ratio of TAVI/surgical valve replacement was comparable in both races. In a propensity matched-analysis (300 matched pairs), in-hospital mortality was not significantly different between groups: 3.7% for Caucasians vs. 3.3% for African Americans (p=0.99). Alqahtani et al report: “Rates of key morbidities including stroke, vascular complications, renal failure, and permanent pacemaker implantation were also similar between Caucasians and African Americans. Also, hospital length of stay, intermediate care facility utilisation and cost of hospitalisation were similar between groups.”
According to Alqahtani et al, the study’s findings suggest that “in contemporary practice, there is no significant racial disparity in the utilisation and outcomes of TAVI in the USA.” They conclude, “Further comparative studies of surgical and TAVI in racial minorities are warranted”.
Implications
Study author Mohamad Alkhouli (West Virginia University Heart & Vascular Institute, Morgantown, USA) told Cardiovascular News: “Although the absolute number of Africa American patients undergoing TAVI is small overall, the ratio of TAVI/surgical valve replacement among African Americans is comparable to that of Caucasian patients. This suggests a possibly lower incidence of aortic stenosis among African Americans patients. However, further studies are needed to assess that. Among patients who undergo TAVI , though, it was reassuring to find that there was no race specific disparity in terms of short term morbidity and mortality of the procedure.”
