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Race may influence outcomes after PCI with paclitaxel-eluting stents
Blacks were more likely than whites to have a long-term risk for major thrombotic events after PCI with paclitaxel-eluting stents, whereas Asians were not, study results showed.
In the study, researchers assessed the influence of race on long-term outcomes following PCI with paclitaxel-eluting stents (PES) by comparing 5-year outcomes of 2,301 whites, 127 blacks and 169 Asians treated with PES in the TAXUS IV, TAXUS V and ATLAS trials.
Compared with whites, blacks were more likely to be women and have a history of hypertension, diabetes, congestive HF and stroke, but less likely to have prior CAD. Whites and Asians were younger, more likely to be men and have stable angina and left anterior descending disease, but less likely to have silent ischemia, previous CABG, prior CAD, diabetes, peripheral vascular disease and to receive glycoprotein IIb/IIIa inhibitors.
Despite higher antiplatelet compliance, the adjusted 5-year rates of MI (15.4% vs. 5.4%; P<.001) and stent thrombosis (5.6% vs. 1.1%; P=.002) were higher in blacks than whites. MACE, cardiac death, all-cause death, target lesion revascularization and target vessel revascularization were not statistically significantly higher. Asians had no differences in MI and stent thrombosis compared with whites despite lower rates of antiplatelet compliance. Between the three groups, rates of mortality and revascularization were similar.
The growing minority population in the United States and the large magnitude of difference in the adjusted risk for stent thrombosis and MI between races offer strong evidence that race influenced long-term thrombotic risk after PES implantation, the researchers wrote
“Most importantly, our findings underscore the need to enhance minority participation in future PCI clinical trials to allow for data-driven decision making when treating an increasingly diverse patient population,” they wrote.