Complex High-risk but indicated Percutaneous coronary interventions (CHiPs) is increasingly
common in contemporary practice. However, data on ethnic differences in CHiP types,
outcomes, and trends in patients with stable angina are limited; this is pertinent
given the population of Black, Asian, and other ethnic minorities (BAME) in Europe
is increasing. We conducted a retrospective analysis of CHiP procedures undertaken
in patients with stable angina using data obtained from the BCIS (British Cardiovascular
Intervention Society) registry (2006 to 2017). CHiP cases were identified and categorized
by ethnicity into White and BAME groups. We then performed multivariable regression
analysis and propensity score matching to determine adjusted odds ratios (aORs) of
in-hospital mortality, major bleeding, and major adverse cardiovascular and cerebral
events (MACCEs) in BAME compared with Whites. Of 424,290 procedure records, 105,949
were CHiP (25.0%) (White 89,038 [84%], BAME 16,911 [16%]). BAME patients were younger
(median 68.1 vs 70.6 years). Previous coronary artery bypass surgery (33.4% vs 38.3%),
followed by chronic total occlusion percutaneous coronary intervention (31.9% vs 32%)
were common CHiP variables in both groups. The third common variable was age 80 years
and above (23.6%) in White patients and severe vascular calcifications in BAME patients
(18.8%). BAME patients had higher rates of diabetes (41.1 vs 23.6%), hypertension
(68 vs 66.5%), previous percutaneous coronary intervention (43.7 vs 37.6%), and previous
myocardial infarction (44.9 vs 42.5%), (p <0.001 for all). Mortality (aOR 1.1, 95%
confidence interval [CI] 0.8 to 1.5) and MACCE (aOR 1.0, 95% CI 0.8 to 1.1) odds were similar among the groups. Bleeding
odds (aOR 0.7, 95% CI 0.6 to 0.9) were lower in BAME. In conclusion, CHiP procedures
differed among the ethnic groups. BAME patients were younger and had worse cardiometabolic
profiles. Similar odds of death and MACCE were seen in BAME compared with their White
counterparts. Bleeding odds were 30% lower in the BAME group.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- In-hospital mortality rates from acute myocardial infarction by race in U.S. hospitals: findings from the National Hospital Discharge Survey.Circulation. 1987; 76: 280-288
- Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs.JAMA. 1994; 271: 1175-1180
- Risk of major adverse cardiovascular events and major hemorrhage among White and Black patients undergoing percutaneous coronary intervention.J Am Heart Assoc. 2019; 8e012874
- NICOR (National Institute for Cardiovascular Outcomes Research). Mortality in South Asians and Caucasians after percutaneous coronary intervention in the United Kingdom: an observational cohort study of 279,256 patients from the BCIS (British Cardiovascular Intervention Society) national database.JACC Cardiovasc Interv. 2014; 7: 362-371
- Racial disparities in left main stenting: insights from a real world inner city population.J Interv Cardiol. 2013; 26: 43-48
- Racial differences in management and outcomes of acute myocardial infarction during COVID-19 pandemic.Heart. 2021; 107: 734-740
- Sex and race differences in the utilization and outcomes of coronary artery bypass grafting among medicare beneficiaries, 1999–2014.J Am Heart Assoc. 2018; 7e009014
- Clinical outcomes of percutaneous coronary intervention for chronic total occlusion in native coronary arteries vs saphenous vein grafts.J Invasive Cardiol. 2020; 32: 350-357
- British Cardiovascular Intervention Society (BCIS) and the National Institute for Cardiovascular Outcomes Research (NICOR). Clinical characteristics and outcomes from percutaneous coronary intervention of last remaining coronary artery: an analysis From the British Cardiovascular Intervention Society database.Circ Cardiovasc Interv. 2020; 13e009049
- Use of percutaneous coronary intervention among Black and White patients with end-stage renal disease in the United States.J Am Heart Assoc. 2019; 8e012101
- Reporting and representation of race/ethnicity in published randomized trials.Am Heart J. 2009; 158: 742-747
- Effect of gender and race on outcomes in dialysis-dependent patients undergoing percutaneous coronary intervention.Am J Cardiol. 2011; 107: 1319-1323
- Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management.J Hum Hypertens. 2007; 21: 183-211
- Ethnic minorities and coronary heart disease: an update and future directions.Curr Atheroscler Rep. 2016; 18: 9
- Ethnic population projections for the UK, 2001–2051.J Popul Res. 2012; 29: 45-89
- British Cardiovascular Intervention Society database: insights into interventional cardiology in the United Kingdom.Heart. 2019; 105: 1289
- British Cardiovascular Intervention Society registry framework: a quality improvement initiative on behalf of the National Institute of Cardiovascular Outcomes Research (NICOR).Eur Heart J Qual Care Clin Outcomes. 2019; 5: 292-297
- British Cardiovascular Intervention Society Registry for audit and quality assessment of percutaneous coronary interventions in the United Kingdom.Heart. 2011; 97: 1293-1297
- Banning A and Mamas M. Complex high-risk and indicated percutaneous coronary intervention for stable angina: Does operator volume influence patient outcome?.Am Heart J. 2020; 222: 15-25
- Revascularisation strategies in patients with significant left main coronary disease during the COVID −19 pandemic.Catheter Cardiovasc Interv. 2021; 98: 1252-1261
- Combining estimates of interest in prognostic modelling studies after multiple imputation: current practice and guidelines.BMC Med Res Methodol. 2009; 9: 57
- Impact of race and ethnicity on the clinical and angiographic characteristics, social determinants of health, and 1-year outcomes after everolimus-eluting coronary stent procedures in women.Circ Cardiovasc Interv. 2019; 12e006918
- Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: associations in a linked electronic health record cohort of 1 million patients.PLoS One. 2017; 12e0178945
- Racial differences in risks for first cardiovascular events and noncardiovascular death: the Atherosclerosis Risk in Communities study, the Cardiovascular Health Study, and the Multi-Ethnic Study of Atherosclerosis.Circulation. 2012; 126: 50-59
- Prior coronary artery bypass graft surgery and outcome after percutaneous coronary intervention: an observational study from the Pan-London percutaneous coronary intervention registry.J Am Heart Assoc. 2020; 9e014409
- Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry).JACC Cardiovasc Interv. 2015; 8: 245-253
- Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer-generation DES: findings from a large multiethnic registry.Catheter Cardiovasc Interv. 2018; 91: 859-866
- Impact of race and ethnicity on inhospital outcomes after percutaneous coronary intervention (report from the 2000–2001 New York State angioplasty Registry).Am Heart J. 2006; 151: 164-167
- Validation of the Academic Research Consortium high bleeding risk definition in contemporary PCI patients.J Am Coll Cardiol. 2020; 75: 2711-2722
- High bleeding risk after percutaneous coronary intervention: impact of race/ethnicity.J Am Coll Cardiol. 2020; 75: 1157
- Comparison of five-year outcome in African Americans versus Caucasians following percutaneous coronary intervention.Catheter Cardiovasc Interv. 2008; 72: 36-44
Article info
Publication history
Published online: May 14, 2022
Received in revised form:
March 10,
2022
Received:
January 18,
2022
Footnotes
Drs. Rashid and Mamas supervised the work equally as senior authors.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
