New analyses from the PLATINUM Diversity study underscore the need for greater understanding of the clinical and nonclinical barriers that can adversely affect stent-related outcomes. The findings of these new analyses were presented during a late-breaking clinical trial session at the annual meeting of the Society for Cardiac Angiography and Interventions (SCAI; 10–13 May, New Orleans, USA).
According to the new analyses, demographic and economic factors impact outcomes one year after stent implantation in various ways:
- Unadjusted rates of combined death, myocardial infarction and target vessel revascularization (TVR) were higher in minority women than white men
- Unadjusted rates of death were higher in white women and minority men than white men
- Unadjusted rates of combined death and myocardial infarction were higher in minority men and women than white men
- After accounting for the differences in baseline clinical and angiographic risk factors, minority women still showed a higher rate of combined death, myocardial infarction and target vessel revascularisation, combined death and myocardial infarction and myocardial infarction alone than white men, a result driven by a nearly four-fold increased risk of myocardial infarction
- After accounting for the differences in baseline clinical and angiographic risk factors, rates of repeat hospitalisation for target vessel revascularisation and stent thrombosis (ST) were similar across all four groups included in the analysis (white men, white women, non-white men and non-white women)
The analyses of PLATINUM Diversity also revealed socioeconomic disparities. Among patients who disclosed annual household income, the study indicated significant differences in the primary clinical endpoint of the composite of death, myocardial infarction and target vessel revascularisation at 12 months. For example, an annual household income of <US$25,000 was associated with a composite rate of death, myocardial infarction, and target vessel revascularisation of 9.8% whereas an annual household income of >$50,000 was associated with a composite rate of 4.1%. After adjustment for all other clinical and angiographic variables, annual income remained an independent predictor of death and combined death and myocardial infarction.
Wayne Batchelor (Tallahassee Memorial Hospital, Tallahassee, USA), co-principal investigator, says: “Clinicians need data that explore both the clinical and social determinants of health that influence outcomes in cardiovascular disease in order to provide all patients with the best possible care. These data from PLATINUM Diversity provide important insights for the cardiology community to consider in addressing inequities in cardiovascular care.”
The PLATINUM Diversity study is an observational, prospective, multicentre, open-label, single-arm, post-approval study that enrolled 1,501 patients at 52 sites in the USA from understudied populations, specifically women, African Americans, Latinos/Hispanics, American Indians or Alaska Natives. All patients in this single arm study received at least one everolimus-eluting platinum chromium stent (Promus Premier, Boston Scientific). Patient data from the Promus Element Plus post-approval study were included in the full analysis to allow for comparisons to white men, increasing the total number of patients to 4,188.