Abstract 17294: The Influence of Race on Treatment and Outcomes in Patients Undergoing Percutaneous Coronary Intervention: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Abstract

Introduction: Disparities in management of coronary artery disease in minorities have been well documented. However, the impact of race on outcomes of patients undergoing percutaneous coronary intervention (PCI) has not been well characterized.

Hypothesis: We assessed the hypothesis that racial disparities exist in the treatment and outcomes of patients undergoing PCI.

Methods: We examined the impact of race on outcomes of patients undergoing PCI between January 1,2010 and December 31, 2011, and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Propensity matching was used to adjust for differences between black and white patients.

Results: 65,175 patients were included of whom 6,873 (10.5%) were black and 55,789 (85.6%) white. Black patients were likely to be younger, female, have more co-morbidities or be uninsured. Black patients were less likely to receive prasugrel (9.3% vs 15.3%, p-value <0.001) and bivalirudin (29.9% vs 38.1%, p-value<0.001), the differences persisted after propensity matching for prasugrel (10.0% vs 14.5%, p-value <0.001) and bivalirudin (28.5% vs 32.8%, p-value<0.001). White patients were more likely to receive drug eluting stents even after propensity matching (67.7% vs 62.5%, adjusted OR 1.30, CI 95%, p-value<0.001). No differences were seen for in-hospital mortality (Table 1). Black patients were more likely to experience contrast induced nephropathy and need for transfusion,after propensity matching, these differences were no longer significant. Black race was associated with decreased risk of heart failure and vascular complications after propensity matching.

Conclusions: Race appears to influence selection of stents and medication use during PCI. Black patients appear to have more complications, but this was explained by co-morbidities and socio-economic status. Black patients appeared to fare better with some clinical outcomes than white patients after propensity matching.