SCAI 2017: Race, gender, socioeconomic status impact PCI outcomes

New research revealed at the Society for Cardiovascular Angiography and Interventions (SCAI) meeting in New Orleans last week showed that being a white man could yield better outcomes when it comes to undergoing a percutaneous coronary intervention (PCI) with a drug-eluting stent.

According to the study, women and minorities who undergo the procedure have worse outcomes, which are attributable directly to their race, ethnicity, sex and socioeconomic status, rather than the PCI. Specifically, the study found that when compared to white men, women and minorities will be put at a greater risk of experiencing recurrent cardiac events within the first year after a PCI procedure.

The research was led by Wayne Batchelor, MD, an interventional cardiologist at Southern Medical Group in Tallahassee, Florida, and Roxana Mehran, MD, the director of interventional cardiovascular research and clinical trials at the Icahn School of Medicine at Mount Sinai in New York.

"We wanted to design a study to prospectively examine outcomes across a large sample of women and minorities and compare that with the same stent used in recent studies of large numbers of Caucasian men," Batchelor said in a statement. "What is unique about our study is that, counter to prevailing assumptions, it shows that you can rapidly enroll women and minorities into a prospective registry and collect statistically valid data."

This is the first prospective study that only enrolled women and minorities, groups that have been historically underrepresented in cardiovascular trials.

Patients in the study, who identified as female, black, Hispanic, American Indian or Alaskan Native, received one of Boston Scientific’s Promus PREMIER stents, and were compared to a cohort of white, male patients. In total, there were 1,417 white and 427 minority women, and 1,635 white and 632 minority men. The researchers looked at one-year outcomes for all patients.

Results showed that severe clinical and angiographic risk factors, including renal disease, diabetes, hypertension and coronary calcification were more common in nonwhite and female individuals than in white men, who were more likely to experience thrombus. Additionally, death, myocardial infarction and target vessel revascularization rates were all higher among nonwhite, female patients.

"What we found was that there were significant differences in adjusted outcomes between these groups, with especially higher risks of cardiac events in minority women at one year," Batchelor said. "However, these incremental risks appeared to be related to progression of the patient's ischemic heart disease more than failure of the stent due to stent thrombosis or restenosis."