Racial difference in cardiovascular outcomes following percutaneous coronary intervention in a public health service patient population.

BACKGROUND: Prior studies have reported conflicting findings regarding racial disparities in long-term cardiovascular outcomes after percutaneous coronary intervention (PCI). Our aim was to compare major adverse cardiac events (MACE) following PCI in black versus non-black patients in a Public Health Service (PHS) setting.

METHODS: A cohort of 1,438 consecutive patients undergoing intended PCI at a large public teaching hospital between April 2002 and September 2006 were followed for the development of MACE, defined as a composite of death, myocardial infarction (MI) and urgent target vessel revascularization.

RESULTS: The study population consisted of 47.4% blacks, 21.3% whites, 15.2% Hispanics and 16.1% Asians. Overall, 17.4% of patients developed MACE over the mean followup period of 2.9 years. The rate of MACE was significantly higher in blacks compared with non-blacks (21.7% vs. 13.6%, log-rank p < 0.001). After adjusting for age, gender, cardiovascular risk factors, socioeconomic status (SES) and potential confounding factors, black race remained a strong and independent predictor of MACE (adjusted HR, 1.52; CI, 1.18-1.96; p = 0.001). Blacks had higher rates of death (12.3% vs. 5.2%, log-rank p < 0.001) and MI (8.7% vs. 4.4%, log rank p = 0.002). There were no racial differences in in-hospital mortality and 3-month and 6-month MACE.

CONCLUSIONS: In this PHS population, blacks were found to have worse long-term cardiovascular outcomes and mortality following PCI, irrespective of differences in baseline cardiovascular risk factors, SES and health-care access.