Outcomes similar in Black, white patients with peripheral endovascular intervention
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Among patients who underwent peripheral endovascular intervention, outcomes were similar between Black and white adults, though Black patients were less likely to have subsequent revascularization, according to data presented at VIVA 21.
“The persistence of disparities in morbidity and mortality after peripheral vascular intervention despite adjustment for demographics, community-level socioeconomic status and hospital-level factors demonstrate that reduction in racial disparities in peripheral artery disease outcomes is unlikely to be primarily driven by care during acute hospitalizations or interventions,” Howard M. Julien, MD, MPH, ML, assistant professor of clinical medicine at Penn Medicine, said during a presentation.
Julien and colleagues retrospectively analyzed 7,429 Black or white patients (mean age, 70 years; 59% men) from the National Cardiovascular Data Registry who underwent lower-extremity peripheral endovascular intervention from April 2014 to March 2019.
Compared with white patients, Black patients were younger, less likely to be men, less likely to have Medicare and more likely to have Medicaid, Julien said.
In addition, Black patients compared with white patients had a greater Distressed Communities Index score; were more likely to have hypertension, diabetes, prior HF and end-stage renal disease; and were less likely to have hyperlipidemia and prior CAD, he said.
Black patients were more likely than white patients to be treated with drug-coated balloons or drug-coated stents (adjusted OR = 1.14; 95% CI, 1.06-1.23), but there were no differences in use of intravascular imaging or atherectomy, according to the researchers.
The groups were similar in procedural success, major vascular complications and major bleeding complications, but Black patients were less likely to have postprocedural acute kidney injury (aOR = 0.79; 95% CI, 0.72-0.88), Julien said.
At 1 year, Black patients were less likely to receive revascularization, whether surgical or endovascular, compared with white patients (aHR = 0.38; 95% CI, 0.28-0.54; P < 001), he said.
There were no differences between the groups at 1 year in death (aHR = 1.02; 95% CI, 0.78-1.35; P = .86), death or major amputation (aHR = 1.18; 95% CI, 0.85-1.64) or major amputation (aHR = 2.5; 95% CI, 0.82-7.63), Julien said.
“In-hospital procedural success and major vascular complication rates were similar between Black and white patients,” Julien said during the presentation. “However, Black patients were less likely to undergo both surgical revascularization or repeat peripheral vascular intervention in the year after their incident [peripheral vascular intervention] procedure, and had a numerically higher rate of major amputation.”
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Julien HM, et al. Late-Breaking Clinical Trials. Presented at: VIVA 21; Oct. 4-7, 2021; Las Vegas (hybrid meeting).
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