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Vyas N, Zaheer A, Wijeysundera HC. Untangling the Complex Multidimensionality of the Social Determinants of Cardiovascular Health: A Systematic Review. Can J Cardiol 2024; 40:1000-1006. [PMID: 38513932 DOI: 10.1016/j.cjca.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/21/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The cardiovascular literature is limited by the lack of consensus on what are the best metrics for reporting social determinants of health (SDH) or social deprivation, and if they should be reported as a single metric or separately by their domains. METHODS A systematic review of the literature on cardiovascular surgeries and procedures was conducted, identifying articles from January 1, 2010, to December 31, 2023, that studied the relationship between health outcomes after cardiovascular procedures or surgeries and SDH/social deprivation. The cardiovascular procedures/surgeries of interest were coronary and valve surgeries and procedures including coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), valve replacement or repair, and transcatheter aortic valve intervention. RESULTS After screening 638 articles, we identified 47 papers that met our inclusion and exclusion criteria. The most common procedure evaluated was CABG and PCI; 46 of the studies focused on these 2 procedures. Almost all of the articles reported a different metric for SDH/social deprivation (41 different metrics); despite this, all of the metrics showed a consistent relationship with worse outcomes associated with greater degrees of SDH/deprivation. Only 9 reported on the individual domains of SDH/social deprivation; 3 studies showed a discordant relationship. CONCLUSIONS Although our systematic review identified numerous articles evaluating the relationship between SDH/social deprivation in cardiovascular disease, there was substantial heterogeneity in which metric was used and how it was reported. This reinforces the need for standards as to the best metrics for SDH/social deprivation as well as best practices for reporting.
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Affiliation(s)
- Navya Vyas
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aida Zaheer
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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2
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Paquin A, Bastiany A, Piché ME. The Complexity of Racial and Ethnic Disparities in Cardiovascular Health: A Role for Underrepresented Populations-Focused Clinics? Can J Cardiol 2023; 39:1667-1669. [PMID: 37897474 DOI: 10.1016/j.cjca.2023.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/11/2023] [Accepted: 08/10/2023] [Indexed: 10/30/2023] Open
Affiliation(s)
- Amélie Paquin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada.
| | - Alexandra Bastiany
- Department of Cardiology, Thunder Bay Regional Health Sciences Center, Thunder Bay, Ontario, Canada
| | - Marie-Eve Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
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Muneeb M, Nuzhat N, Khan Niazi A, Khan AH, Chatha Z, Kazmi T, Farhat S. Assessment of the Dimensions of Coronary Arteries for the Manifestation of Coronary Artery Disease. Cureus 2023; 15:e46606. [PMID: 37937019 PMCID: PMC10625989 DOI: 10.7759/cureus.46606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
INTRODUCTION The size of the coronary artery influences the effective outcome of therapeutic measures like coronary artery bypass graft (CABG) surgery, percutaneous coronary interventions (PCI), and diagnosis of coronary artery disease. Patients' age, gender, BMI, anatomical variations, and increased left ventricular size all have an effect on coronary artery parameters. OBJECTIVE This study aims to compare the average size of the coronary arteries of the Pakistani population in both sexes for manifestation of coronary artery disease. METHODOLOGY For the analysis of the coronary arteries, 100 patients of both sexes, male and female, were taken. X-ray angiography was performed for two-dimensional images of coronary arteries. For diameter measurement, images were visualized on quantitative coronary angiography (QCA) in different views (caudal and cranial views). The diameters of the left main coronary artery (left main stem/LMS), left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA) were measured on angiograms. Data about the dimensions of the coronary artery was gathered through quantitative angiography. Data analysis was done through SPSS version 26 (IBM Corp., Armonk, NY). RESULTS There is a notable distinction in the average diameters among the proximal LAD (3.12), mid-LAD (2.40), and distal LAD (1.29). A statistically significant difference is evident among mid-LCx, distal LCx, and proximal LCx (p-value < 0.001). Likewise, the average diameter of the distal RCA (1.89) was smaller when compared to the mid-RCA (3.19) and proximal RCA (3.78). However, there was no significant difference in the average diameter among mid-LMS, distal LMS, and proximal LMS (p-value = 0.09). CONCLUSION The average diameter of distal RCA was smaller when compared to mid-RCA and proximal RCA. The average size of proximal LAD and proximal LCx was comparatively larger than mid- and distal LAD and LCx. The findings of current research will be beneficial for the diagnosis and management of coronary artery disease patients.
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Affiliation(s)
- Muhammad Muneeb
- Interventional Cardiology, Shalamar Medical and Dental College, Lahore, PAK
| | - Nasia Nuzhat
- Applied Physics, University of Engineering and Technology, Lahore, PAK
| | | | - Ammar H Khan
- Cardiovascular Surgery, Imran Idrees Hospital, Sialkot, PAK
| | - Zanib Chatha
- Interventional Cardiology, Shalamar Medical and Dental College, Lahore, PAK
| | - Tahseen Kazmi
- Community Medicine, Central Park Medical College, Lahore, PAK
| | - Saira Farhat
- Community Medicine, Central Park Medical College, Lahore, PAK
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Bhasin V, Hiltner E, Singh A, Elsaid O, Awasthi A, Kassotis J, Sethi A. Disparities in Drug-Eluting Stent Utilization in Patients With Acute ST-Elevation Myocardial Infarction: An Analysis of the National Inpatient Sample. Angiology 2022:33197221121027. [PMID: 35977920 DOI: 10.1177/00033197221121027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The superiority of drug-eluting stents (DES) compared with bare-metal stents (BMS) is well-established, but data regarding DES use in ST-elevation myocardial infarction (STEMI) as a function of race is limited. Our goal was to examine stent utilization patterns and disparities based on race, sex, and insurance status in patients with STEMI undergoing percutaneous coronary intervention. The National Inpatient Sample database was used to retrospectively compare DES vs BMS use in patients admitted with STEMI from 2009 to 2018. Multivariable logistic regression was performed to assess the independent predictors of DES use. DES utilization increased significantly from 62.8% in 2009 to 94.0% in 2018. However, African Americans were less likely to receive a DES (odds ratio [OR] .82, 95% confidence interval [CI] .77-.87) compared with Caucasians. Women were more likely to undergo DES implantation (OR 1.07, 95% CI 1.05-1.10). Patients insured by Medicaid (OR .84, 95% CI .80-.89) and those classified as Self-pay (OR .63, 95% CI .61-.66) were less likely to undergo DES implantation compared to those with private insurance (OR 1.33, 95% CI 1.29-1.38). Disparities based on race and insurance status continue to persist despite a significant increase in DES utilization in STEMI patients across the identified subgroups.
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Affiliation(s)
- Varun Bhasin
- Division of Cardiology, Department of Medicine, 12287Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Emily Hiltner
- Division of Cardiology, Department of Medicine, 12287Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anjuli Singh
- Division of Cardiology, Department of Medicine, 12287Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ossama Elsaid
- Division of Cardiology, Department of Medicine, 12287Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ashish Awasthi
- Division of Cardiology, 25044Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - John Kassotis
- Division of Cardiology, Department of Medicine, 12287Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ankur Sethi
- Division of Cardiology, 25044Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
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Shamkhani W, Kinnaird T, Wijeysundera HC, Ludman P, Rashid M, Mamas MA. Ethnicity in Complex High-Risk but Indicated Percutaneous Coronary Intervention Types and Outcomes. Am J Cardiol 2022; 175:26-37. [PMID: 35581040 DOI: 10.1016/j.amjcard.2022.03.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
Complex High-risk but indicated Percutaneous coronary interventions (CHiPs) is increasingly common in contemporary practice. However, data on ethnic differences in CHiP types, outcomes, and trends in patients with stable angina are limited; this is pertinent given the population of Black, Asian, and other ethnic minorities (BAME) in Europe is increasing. We conducted a retrospective analysis of CHiP procedures undertaken in patients with stable angina using data obtained from the BCIS (British Cardiovascular Intervention Society) registry (2006 to 2017). CHiP cases were identified and categorized by ethnicity into White and BAME groups. We then performed multivariable regression analysis and propensity score matching to determine adjusted odds ratios (aORs) of in-hospital mortality, major bleeding, and major adverse cardiovascular and cerebral events (MACCEs) in BAME compared with Whites. Of 424,290 procedure records, 105,949 were CHiP (25.0%) (White 89,038 [84%], BAME 16,911 [16%]). BAME patients were younger (median 68.1 vs 70.6 years). Previous coronary artery bypass surgery (33.4% vs 38.3%), followed by chronic total occlusion percutaneous coronary intervention (31.9% vs 32%) were common CHiP variables in both groups. The third common variable was age 80 years and above (23.6%) in White patients and severe vascular calcifications in BAME patients (18.8%). BAME patients had higher rates of diabetes (41.1 vs 23.6%), hypertension (68 vs 66.5%), previous percutaneous coronary intervention (43.7 vs 37.6%), and previous myocardial infarction (44.9 vs 42.5%), (p <0.001 for all). Mortality (aOR 1.1, 95% confidence interval [CI] 0.8 to 1.5) and MACCE (aOR 1.0, 95% CI 0.8 to 1.1) odds were similar among the groups. Bleeding odds (aOR 0.7, 95% CI 0.6 to 0.9) were lower in BAME. In conclusion, CHiP procedures differed among the ethnic groups. BAME patients were younger and had worse cardiometabolic profiles. Similar odds of death and MACCE were seen in BAME compared with their White counterparts. Bleeding odds were 30% lower in the BAME group.
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Affiliation(s)
- Warkaa Shamkhani
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Tim Kinnaird
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Peter Ludman
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 521] [Impact Index Per Article: 173.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Greco A, Capodanno D. Differences in coronary artery disease and outcomes of percutaneous coronary intervention with drug-eluting stents in women and men. Expert Rev Cardiovasc Ther 2021; 19:301-312. [PMID: 33706641 DOI: 10.1080/14779072.2021.1902806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Despite common perceptions, coronary artery disease (CAD) is not a male-specific condition, and sex-based differences do occur in many aspects, including clinical outcomes after percutaneous coronary intervention (PCI) with stent implantation. New-generation drug-eluting stents (DES) significantly improved post-PCI outcomes. However, no sex-specific guidelines on PCI and the use of DES are available as current evidence was derived from clinical trials enrolling predominantly male patients. AREAS COVERED This review aims at exploring sex-based disparities in CAD characteristics and manifestations, and comparing PCI outcomes and the efficacy and safety profiles of DES according to sex. In addition, a critical approach to trials' interpretation with an analysis of sources of bias is provided to inform future research and clinical practice. EXPERT OPINION Sex gap in clinical outcomes after PCI with DES implantation is narrowing due to improved performances of new-generation DES. However, scientific research and biomedical engineering are striving to optimize DES profiles and generate new iterations of devices. At the same time, gender initiatives and sex-specific trials are accruing to overcome current issues in the field. Advances in these areas will foster improvements in early and long-term clinical outcomes of both women and men.
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Affiliation(s)
- Antonio Greco
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - S. Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - S. Marco", University of Catania, Catania, Italy
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Gender-related differences after acute myocardial infarction: A major global health challenge. Int J Cardiol 2020; 311:18-19. [DOI: 10.1016/j.ijcard.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 11/19/2022]
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Krackhardt F, Waliszewski M, Wan Ahmad WA, Kočka V, Toušek P, Janek B, Trenčan M, Krajči P, Lozano F, Garcia-San Roman K, Otaegui Irurueta I, Garcia del Blanco B, Wachowiak L, Vilalta del Olmo V, Fernandez Nofrerías E, Ho Jeong M, Jung BC, Han KR, Piot C, Sebagh L, Rischner J, Pansieri M, Leschke M, Ahn TH. Polymer-free sirolimus-eluting stent use in Europe and Asia: Ethnic differences in demographics and clinical outcomes. PLoS One 2020; 15:e0226606. [PMID: 31929543 PMCID: PMC6957170 DOI: 10.1371/journal.pone.0226606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/29/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The objective of this study was to assess regional and ethnic differences in an unselected patient population treated with polymer-free sirolimus-eluting stents (PF-SES) in Asia and Europe. METHODS Two all-comers observational studies based on the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were combined for data analysis to assure sufficient statistical power. The primary endpoint was the accumulated target lesion revascularization (TLR) rate at 9-12 months. RESULTS Of the total population of 7243 patients, 44.0% (3186) were recruited in the Mediterranean region and 32.0% (2317) in central Europe. The most prominent Asian region was South Korea (17.6%, 1274) followed by Malaysia (5.7%, 413). Major cardiovascular risk factors varied significantly across regions. The overall rates for accumulated TLR and MACE were low with 2.2% (140/6374) and 4.4% (279/6374), respectively. In ACS patients, there were no differences in terms of MACE, TLR, MI and accumulated mortality between the investigated regions. Moreover, dual antiplatelet therapy (DAPT) regimens were substantially longer in Asian countries even in patients with stable coronary artery disease as compared to those in Europe. CONCLUSIONS PF-SES angioplasty is associated with low clinical event rates in all regions. Further reductions in clinical event rates seem to be associated with longer DAPT regimens.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité–Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
- * E-mail:
| | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology, Charité–Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
| | | | - Viktor Kočka
- University Hospital Královské Vinohrady Prague, Czech Republic
| | - Petr Toušek
- University Hospital Královské Vinohrady Prague, Czech Republic
| | | | | | | | - Fernando Lozano
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | - Lucie Wachowiak
- Medical Scientific Affairs, B.Braun France, Saint-Cloud, France
| | | | | | | | | | - Kyu-Rock Han
- Kangdong Sacred Heart Hospital, Kangdong, South Korea
| | | | | | | | | | | | - Tae Hoon Ahn
- Gachon University Gil Medical Center, Incheon, South Korea
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Racial Disparities in Clinical Characteristics and Outcomes of Women Undergoing Percutaneous Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1039-1042. [PMID: 31678115 DOI: 10.1016/j.carrev.2019.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE Women are underrepresented in cardiovascular clinical studies. Black women have a higher ischemic heart disease mortality risk than their white counterparts. However, there exist limited outcome data comparing black women and white women after percutaneous coronary intervention (PCI). The aim of this retrospective analysis was to evaluate for racial disparities in 1-year major adverse cardiovascular events (MACE) in women undergoing PCI. METHODS/MATERIALS Within our PCI database, we identified 4776 female patients who underwent PCI between 2003 and 2016. Of those, 1916 were black and 2860 were white. Endpoints included MACE, death, myocardial infarction, target vessel revascularization (TVR) and stent thrombosis (ST) at 30 days and 1 year. A proportional Cox hazard model analysis was performed to assess outcomes after adjustment for confounding factors. RESULTS Black women presented at a younger age and had a significantly higher prevalence of risk factors. Periprocedural and in-hospital outcomes were similar in the 2 groups. At 30 days and 1 year, the rates of myocardial infarction, TVR and ST were significantly higher in black women. After adjustment for baseline differences, only ST appears to be more likely to occur in black women than in white women. CONCLUSIONS In this large cohort of women with coronary artery disease undergoing PCI, we observed racial disparities primarily in baseline characteristics indicative of need for interventions to achieve early diagnosis and better prevention in black women. Future directions should include efforts to identify and better characterize the factors underlying and contributing to cardiovascular outcomes in women after PCI. SUMMARY In this real-world analysis from a large cohort of women with coronary artery disease undergoing percutaneous coronary intervention at a US tertiary-care center, racial disparities were observed, especially in baseline characteristics, indicating late presentation.
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