Study shows race doesn't affect PCI outcomes—but does influence treatment decisions

A new JAMA: Cardiology study comparing the outcomes of percutaneous coronary intervention (PCI) in black and white patients showed no difference in one-year mortality rates, but it did shed light on other racial gaps in the cardiovascular treatment process.

A team of researchers pulled data for more than 40,000 heart disease patients at 63 U.S. Veterans Affairs (VA) hospitals from the VA Clinical Assessment, Reporting and Tracking System for Cardiac Catheterization Laboratories program and evaluated the outcomes of black and white patients who underwent PCI between October 2007 and September 2013. Patients who were of different races or identified as mixed race were excluded from the study. Of the 42,391 subjects identified, just 13.3 percent were black. Almost all were men.

Jay Giri, MD, MPH, and colleagues used a generalized linear mixed model to assess the odds of outcomes in both races, and adjusted for demographic data, comorbidities and procedural characteristics between the groups. Primary outcome was one-year mortality, Giri and co-authors wrote, while secondary outcomes of the PCI procedure included 30-day all-cause hospital readmission rates, 30-day acute kidney injury, 30-day blood transfusions and one-year readmission rates for myocardial infarction (MI).

In unadjusted results, Giri and colleagues found black patients had higher one-year mortality rates than white patients, at 7.1 percent and 5.9 percent, respectively. Black patients also saw greater rates of 30-day acute kidney injury, 30-day blood transfusions and one-year readmission rates for MI. After adjusting the data, though, researchers found little to no difference between racial groups when it came to both primary and secondary outcomes of PCI.

The researchers quickly concluded race wasn’t an independent factor influencing the outcome of PCI at VA hospitals, but also noted in the study black patients seemed to be receiving less comprehensive care than white patients.

Black patients were less likely to receive a drug-eluting stent than white patients, regardless of their diagnosis of stable coronary artery disease or acute coronary syndrome, the authors wrote. They were also less likely to be prescribed beta-blockers after PCI, suggesting the need for further research into racial differences in cardiovascular care in both VA and non-VA populations.