Women, minorities see higher risk of ischemic events than white men following stent implantation

Women and minorities experience a higher risk of recurrent ischemic events than white men following everolimus-eluting stent implantation, a JAMA Cardiology study recently found.

Author Wayne Batchelor, MD, MHS, and colleagues pulled thousands of patients from the PLATINUM Diversity and PROMUS Element Plus Post-Approval studies—men, women and minorities—in an effort to evaluate how the groups differed in outcomes after undergoing percutaneous coronary intervention (PCI).

The authors said they focused on minorities in this study because, despite the fact that minorities are predicted to make up more than half of the U.S. population by 2060, most cardiovascular clinical trials employ only white men. Women and minorities also tend to present with more comorbidities than white men do, Batchelor and co-authors wrote in the study.

Patients were enrolled in the trial starting in October 2014, Batchelor and co-authors wrote, and were followed for a year after the implantation of at least one drug-eluting stent. The primary endpoints were major adverse cardiac events, which included death, myocardial infarction and target vessel revascularization, and secondary ischemic endpoints were also taken into account.

In all, the study pooled 4,182 patients, the majority of whom were women and minorities. At baseline, women and minorities had higher rates of diabetes, prior strokes, hypertension, renal disease and congestive heart failure than white men, the authors reported, but lower prevalence of smoking, multivessel disease, prior coronary artery bypass graft surgery and prior myocardial infarction (MI).

Batchelor and colleagues found one-year outcome rates for major adverse cardiovascular events (MACE) were similar between the study cohorts, but the adjusted risk of death and MI was higher among women and minorities. However, these elevated risk rates were mostly due to nonstent-related heart attacks, the authors said.

The researchers identified cardiogenic shock, renal disease, history of peripheral vascular disease, multivessel disease, widowhood and lack of private insurance as predictors for MACE in the PLATINUM Diversity cohort, which included more than 1,500 patients across 52 U.S. sites.

Although they didn’t find major gaps between sexes and races, Batchelor and co-authors wrote, “there remains an opportunity to reduce an incremental risk of recurrent nonstent-related ischemic events in women and minority patients after percutaneous coronary intervention.”

“Our data suggest that differential risks of thrombosis or atherosclerosis contribute more to this phenomenon than stent failure,” they said. “In providing a comprehensive evaluation of the impact of race/ethnicity, sex and social determinants of health on contemporary PCI outcomes, this study contributes significantly to our current knowledge base.”