Racial differences in long-term outcomes among black and white patients with drug-eluting stents

Am Heart J. 2019 Aug:214:46-53. doi: 10.1016/j.ahj.2019.04.005. Epub 2019 Apr 15.

Abstract

Background: Some studies suggest that black patients may have worse outcomes after drug-eluting stent (DES) placement. There are limited data characterizing long-term outcomes by race. The objective was to compare long-term outcomes between black and white patients after percutaneous coronary intervention (PCI) with DES implantation.

Methods: We analyzed 915 black and 3,559 white (n = 4,474) consecutive patients who underwent DES placement at Duke University Medical Center from 2005 through 2013. Over 6-year follow up, we compared rates of myocardial infarction (MI), all-cause mortality, revascularization, and major bleeding between black and white patients. A multivariable Cox regression model was fit to adjust for potentially confounding variables. Dual-antiplatelet therapy use over time was determined by patient follow-up surveys and compared by race.

Results: Black patients were younger; were more often female; had higher body mass indexes; had more diabetes mellitus, hypertension, and renal disease; and had lower median household incomes than white patients (P < .001). At 6 years after DES placement, black relative to white patients had higher unadjusted rates of MI (12.1% vs 10.1%, hazard ratio 1.25, 95% CI 1.00-1.57, P = .05) and major bleeding (17.8% vs 14.3%, hazard ratio 1.28, 95% CI 1.07-1.54, P = .01), but there were no significant differences in other outcomes. After multivariable adjustment, there were no statistically significant racial differences in any of these outcomes at 6 years. Similarly, dual-antiplatelet therapy use was comparable between racial groups.

Conclusions: Unadjusted rates of MI and major bleeding over long-term follow up were higher among black patients compared to white patients, but these differences may be explained by racial differences in comorbid disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angina Pectoris / therapy
  • Angina, Unstable / therapy
  • Black People* / statistics & numerical data
  • Body Mass Index
  • Cause of Death
  • Databases, Factual / statistics & numerical data
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / ethnology
  • Drug-Eluting Stents* / adverse effects
  • Drug-Eluting Stents* / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Hemorrhage / epidemiology
  • Hemorrhage / ethnology
  • Humans
  • Hypertension / epidemiology
  • Hypertension / ethnology
  • Income / statistics & numerical data
  • Kaplan-Meier Estimate
  • Kidney Diseases / epidemiology
  • Kidney Diseases / ethnology
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / ethnology
  • Myocardial Revascularization / statistics & numerical data
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / statistics & numerical data
  • Platelet Aggregation Inhibitors / therapeutic use
  • ST Elevation Myocardial Infarction / therapy
  • Treatment Outcome
  • White People* / statistics & numerical data

Substances

  • Platelet Aggregation Inhibitors