Comparison of six-month outcomes after percutaneous coronary intervention for Whites versus African-Americans.

S differences have been noted between whites and African Americans (AA) in the utilization of coronary angiography, coronary artery bypass grafting (CABG), and reperfusion therapy even after adjustment for clinical factors.1–4 Whites undergo a third more catheterizations and more than twice as many CABGs and percutaneous coronary interventions (PCIs).1,2,5–12 It could be suggested that the higher cardiovascular mortality rate among AA13,14 is related in part to the reported disparity in the use of these procedures. This apparent referral bias may reflect a perception that the outcomes of PCI and CABG are less favorable in AA.15,16 In a previous study from this institution we found no differences in in-hospital outcomes among different ethnic groups.17 We undertook this analysis to determine whether ethnicity plays a role in morbidity and mortality after PCI over a longer follow-up period. • • • This analysis was approved by the Institutional Review Board of the MedStar Health Research Institute; 2,979 consecutive patients underwent PCI from September to December 1996 (n 5 1,029) and April to September 1998 (n 5 1,950) in the cardiac catheterization laboratory of this institution. Data were analyzed for the 2,842 patients (95.4%) for whom 6-month follow-up information was obtained. Of these 2,381 (83.8%) were identified from the admissions datasheet as whites, and 339 as AA (11.9%). Data from Hispanics (n 5 80) and Asians (n 5 42) were not analyzed. PCI was carried out by standard techniques by 54 operators. Each chose the treatment modality based on the size of the artery containing the target lesion as well as the location and characteristics of that lesion. Endoluminal stents were placed at the discretion of the operator, either as a planned procedure or as a “bail out” for abrupt closure, threatened closure, or other unsatisfactory angiographic outcome. Retrospective chart review was conducted by trained research assistants to record baseline data and in-hospital events. The operator recorded procedural details, including a visual assessment of the location and angiographic characteristics of the target lesion. In any instance of attempted multilesion treatment, each patient was assigned an American College of Cardiology/American Heart Association complexity category18 based on the most complex lesion targeted. Follow-up was obtained by mail or telephone interview. The National Death Registry was consulted for all patients for whom no other follow-up was available. All reported events were confirmed from medical records of the events. Continuous variables are expressed as mean 6 SD and were compared by means of analysis of variance. Discrete variables were compared by means of contingency tables and chi-square analysis with Yates’ correction. Fisher’s exact test was used when appropriate. A p ,0.05 was considered significant. Multivariate logistic regression (SAS software, version 8.1, SAS Institute, Cary, North Carolina) was used to identify independent predictors of the outcome variables. The baseline clinical, angiographic, and procedural characteristics are compared in Table 1. AA were more often female, more often had diabetes, and other comorbid illnesses, and they were sicker on presentation to the hospital. Table 2 compares the 6-month outcomes. No significant difference was found for individual end points or for a composite end point including any of these events. Mortality was higher for AA but this did not reach significance even after adjustment for independent predictors of mortality (i.e., age, renal insufficiency, shock, prior myocardial infarction, or evolving myocardial infarction). It is, of course, possible that a larger sample size might identify a significant difference; however, the number of patients in this analysis provided a .80% chance of identifying a doubling of mortality. • • • This analysis includes an unselected, consecutive cohort from a single center, and as such, is potentially generalizeable to many populations. Although the experience cited is from an inner city hospital in the District of Columbia where most of the population is AA, this study has a relatively small number of AA patients. Whether this represents a referral bias cannot be determined from our data. In contrast to previous studies that suggest less favorable outcomes of CABG in AA patients,17,18 this analysis, similar to the New Approaches in Coronary Interventions Registry,19 demonstrates comparable rates of complications and need for additional revascularization in the 6 months after PCI. Concerns about race-related differences in procedural success and complications should not dissuade physicians from performing PCI when clinically indicated.