African American-Caucasian American Differences in Aortic Valve Replacement in Patients with Severe Aortic Stenosis: Racial Differences in AVR.

BACKGROUND: Among patients with severe aortic stenosis (AS), there are limited data on aortic valve replacement (AVR), reasons for non-receipt and mortality by race.

METHODS: Utilizing the Duke Echocardiography Laboratory Database, we analyzed data from 110,711 patients who underwent echocardiography at Duke University Medical Center between 1999-2013. We identified 1,111 patients with severe AS who met ≥1 of 3 criteria for AVR: ejection fraction ≤50%, diagnosis of heart failure, or need for coronary artery bypass surgery. Logistic regression models were used to assess the association between race, AVR and 1-year mortality. Chi-squared testing was used to assess potential racial differences in reasons for AVR non-receipt.

RESULTS: Among the 1,111 patients (143 AA and 968 CA) eligible for AVR, AA were more often women, had more diabetes, renal insufficiency, aortic regurgitation and left ventricular hypertrophy. CA were more often smokers, had more ischemic heart disease, hyperlipidemia and higher median income levels. There were no racial differences in surgical risk utilizing logistic euroSCORES. Relative to CA, AA had lower rates of AVR (aOR 0.46, 95% CI 0.3-0.71, p<0.001) yet similar 1-year mortality (aHR 0.81, 95% CI 0.57-1.17, p=0.262). There were no significant differences in reasons for AVR non-receipt.

CONCLUSION: Among patients with severe AS eligible for AVR, AA patients were less likely to undergo AVR. Despite racial differences in AVR, there were no significant differences in mortality within 1-year or reasons for AVR non-receipt.