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Risk for recurrent ischemic events increased in women, minorities after PCI
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Women and minorities who underwent contemporary everolimus-eluting stent implantation had an increased risk for recurrent ischemic events compared with white men, and all three groups had similar risk for MACE at 1 year, according to a study published in JAMA Cardiology.
Everolimus-eluting stent trials
Wayne Batchelor, MD, MHS, of Florida State University College of Medicine in Tallahassee, and colleagues analyzed data from 4,182 patients from the PLATINUM Diversity (n = 1,501) and PROMUS Element Plus post-approval trials (n = 2,681) who received one or more everolimus-eluting stents (Promus Premier, Boston Scientific). Patients from the PLATINUM Diversity trial were at least one of the following: Hispanic/Latino, female, American Indian/Alaskan Native or black.
The primary endpoint was the incidence of MACE, a composite of MI, all-cause death and target vessel revascularization, at 1 year. Secondary endpoints analyzed at 1 year included target vessel failure, cardiac and noncardiac death, death or MI, Academic Research Consortium definite/probable stent thrombosis and stent-related or nonstent-related MI.
Outcomes for women (white or minority; 44.5%) and minorities (women or men; 25.3%) were compared with those for white men (39.1%).
Women and minorities had an increased rate of prior stroke, diabetes, renal disease, hypertension and congestive HF, and lower incidence of prior CABG, multivessel disease, smoking and prior MI compared with white men.
At 1 year, unadjusted MACE rates were similar among white men (7.6%), women (8.6%; P = .33) and minorities (9.6%; P = .08). The similarity remained after adjusting for differences in baseline characteristics.
The risk-adjusted rate of death or MI was higher in minorities (OR = 1.9; 95% CI, 1.22-2.8) and women (OR = 1.6; 95% CI, 1.11-2.39) vs. white men. The adjusted risk for MI was higher in minorities (OR = 2.6; 95% CI, 1.4-4.82) compared with white men. Nonstent-related MIs contribute to differences in MI rates, according to the study.
The difference was mostly explained by MIs not related to the stent, Batchelor and colleagues wrote.
MACE predictors
Independent predictors of MACE in women and minorities from the PLATNIUM Diversity cohort included renal disease, cardiogenic shock, multivessel disease, peripheral vascular disease, lack of private insurance and widowed status.
“These findings ... suggest that clinical and angiographic factors and [social determinants of health] may all affect post-PCI outcomes,” Batchelor and colleagues wrote. “Accordingly, we encourage future PCI outcomes studies to collect and report data on [social determinants of health] in addition to conventional PCI risk factors.”
“These important between-group differences cannot be discounted, but are often not evaluated in other race/ethnicity-based studies,” Clyde W. Yancy, MD, MSc, vice dean of diversity and inclusion, Magerstadt Professor of Medicine, professor of medical social sciences and chief of the division of cardiology at Northwestern University Feinberg School of Medicine and associate director of Bluhm Cardiovascular Institute, and Ajay J. Kirtane, MD, SM, cardiologist, chief academic officer at the Center for Interventional Vascular Therapy at Columbia University Medical Center, director of NewYork-Presbyterian and Columbia Catheterization Laboratories and a member of the Cardiology Today’s Intervention Editorial Board, wrote in an accompanying editor’s note. “When combined with clinical descriptors, this approach may get us closer to the truth. What was heretofore attributable to inexplicable race/ethnicity-based differences may now be more clearly associated with both biological and social constructs, perhaps independent of race/ethnicity, that incorporate compelling life experiences that may more directly and profoundly impact health.” – by Darlene Dobkowski
Disclosures: Batchelor reports he receives institutional grant/research support from Boston Scientific and consults for Abbott, Boston Scientific and Medtronic. Kirtane and Yancy report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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