Abstract 19665: Long-Term Outcomes after Percutaneous Coronary Intervention with Paclitaxel-Eluting Coronary Stents in Black versus White Patients
Introduction: Racial disparities persist in the morbidity and mortality associated with coronary artery disease. Despite an increasingly diverse US population, data on the influence of race/ethnicity on long-term outcomes following contemporary percutaneous coronary intervention (PCI) are limited due to severe under-representation of minority populations in randomized trials.
Methods: We conducted a retrospective analysis of 2,301 White and 127 Black patients treated with paclitaxel-eluting stents (PES) in TAXUS IV, V, and ATLAS trials to compare safety and efficacy outcomes through 5 years post PCI. To minimize bias due to imbalanced sample sizes and baseline differences, 1:4 matching was performed and a propensity score adjustment was used to generate a logistic regression model.
Results: Compared with White patients, Black patients were more likely to be female, have a history of hypertension, diabetes mellitus, congestive heart failure, and stroke, but were less likely to have prior coronary artery disease. After adjustment for baseline differences, the 5-year rates of myocardial infarction and stent thrombosis were significantly higher in Black patients, despite similar protocol-mandated compliance with anti-platelet medications. However, rates of target vessel revascularization, target lesion revascularization, and death were not significantly different between the two groups.
Conclusions: Baseline comorbid conditions were more often present in Black patients in the TAXUS clinical trial setting, similar to observations within the general US population. Although the 5-year rates of mortality and revascularization after PES in Black and White patients were comparable, Black patients experienced higher rates of myocardial infarction and stent thrombosis. These observations underscore the importance of further investigations to allow individualized revascularization strategies to be developed for a diverse patient population.
- © 2010 by American Heart Association, Inc.