Taisei Kobayashi1,2, Thomas J Glorioso3,4,5,6, Ehrin J Armstrong3,4,5, Thomas M Maddox3,4,5,6, Mary E Plomondon3,4,5,6, Gary K Grunwald3,4,5,6, Steven M Bradley3,4,5, Thomas T Tsai3,4,5, Stephen W Waldo3,4,5, Sunil V Rao7,8, Subhash Banerjee9,10, Brahmajee K Nallamothu11,12, Deepak L Bhatt13,14,15, A Garvey Rene1,2, Robert L Wilensky1,2, Peter W Groeneveld1,2, Jay Giri1,2. 1. Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania. 2. Penn Cardiovascular Outcomes, Quality, and Evaluation Research Center, Philadelphia, Pennsylvania. 3. Veterans Affairs Eastern Colorado Healthcare System, Denver. 4. University of Colorado School of Medicine, Aurora. 5. Colorado Cardiovascular Outcomes Research Consortium, Denver. 6. Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora. 7. Durham Veterans Affairs Medical Center, Durham, North Carolina. 8. Duke University, Durham, North Carolina. 9. Veterans Affairs North Texas Healthcare System, Dallas. 10. University of Texas Southwestern Medical Center, Dallas. 11. Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan. 12. University of Michigan, Ann Arbor. 13. Veterans Affairs Boston Healthcare System, Boston, Massachusetts. 14. Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts. 15. Harvard Medical School, Boston, Massachusetts.
Abstract
Importance: Current comparative outcomes among black and white patients treated with percutaneous coronary intervention (PCI) in the Veterans Affairs (VA) health system are not known. Objective: To compare outcomes between black and white patients undergoing PCI in the VA health system. Design, Setting, and Participants: This study compared black and white patients who underwent PCI between October 1, 2007, and September 30, 2013, at 63 VA hospitals using data recorded in the VA Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories (CART-CL) program. A generalized linear mixed model with a random intercept for site assessed the relative difference in odds of outcomes between black and white patients. The setting was integrated institutionalized hospital care. Excluded were all patients of other races or those with multiple listed races and those with missing data regarding race or the diagnostic cardiac catheterization. The dates of analysis were January 7, 2016, to April 17, 2017. Exposure: Percutaneous coronary intervention at a VA hospital. Main Outcomes and Measures: The primary outcome was 1-year mortality. Secondary outcomes were 30-day all-cause readmission rates, 30-day acute kidney injury, 30-day blood transfusion, and 1-year readmission rates for myocardial infarction. In addition, variations in procedural and postprocedural care were examined, including the use of intravascular ultrasound, optical coherence tomography, fractional flow reserve measurements, bare-metal stents, postprocedural medications, and radial access. Results: A total of 42 391 patients (13.3% black and 98.4% male; mean [SD] age, 65.2 [9.1] years) satisfied the inclusion and exclusion criteria. In unadjusted analyses, black patients had higher rates of 1-year mortality (7.1% vs 5.9%, P < .001) as well as secondary outcomes of 30-day acute kidney injury (20.8% vs 13.8%, P < .001), 30-day blood transfusion (3.4% vs 2.7%, P < .01), and 1-year readmission rates for myocardial infarction (3.3% vs 2.7%, P = .01) compared with white patients. After adjustment for demographics, comorbidities, and procedural characteristics, odds for 1-year mortality (odds ratio, 1.04; 95% CI, 0.90-1.19) were not different between black and white patients. There were also no differences in secondary outcomes with the exception of a higher rate of adjusted 30-day acute kidney injury (odds ratio, 1.22; 95% CI, 1.10-1.36). Conclusions and Relevance: While black patients had a higher rate of mortality than white patients in unadjusted analyses, race was not independently associated with 1-year mortality among patients undergoing PCI in VA hospitals.
Importance: Current comparative outcomes among black and whitepatients treated with percutaneous coronary intervention (PCI) in the Veterans Affairs (VA) health system are not known. Objective: To compare outcomes between black and whitepatients undergoing PCI in the VA health system. Design, Setting, and Participants: This study compared black and whitepatients who underwent PCI between October 1, 2007, and September 30, 2013, at 63 VA hospitals using data recorded in the VA Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories (CART-CL) program. A generalized linear mixed model with a random intercept for site assessed the relative difference in odds of outcomes between black and whitepatients. The setting was integrated institutionalized hospital care. Excluded were all patients of other races or those with multiple listed races and those with missing data regarding race or the diagnostic cardiac catheterization. The dates of analysis were January 7, 2016, to April 17, 2017. Exposure: Percutaneous coronary intervention at a VA hospital. Main Outcomes and Measures: The primary outcome was 1-year mortality. Secondary outcomes were 30-day all-cause readmission rates, 30-day acute kidney injury, 30-day blood transfusion, and 1-year readmission rates for myocardial infarction. In addition, variations in procedural and postprocedural care were examined, including the use of intravascular ultrasound, optical coherence tomography, fractional flow reserve measurements, bare-metal stents, postprocedural medications, and radial access. Results: A total of 42 391 patients (13.3% black and 98.4% male; mean [SD] age, 65.2 [9.1] years) satisfied the inclusion and exclusion criteria. In unadjusted analyses, black patients had higher rates of 1-year mortality (7.1% vs 5.9%, P < .001) as well as secondary outcomes of 30-day acute kidney injury (20.8% vs 13.8%, P < .001), 30-day blood transfusion (3.4% vs 2.7%, P < .01), and 1-year readmission rates for myocardial infarction (3.3% vs 2.7%, P = .01) compared with whitepatients. After adjustment for demographics, comorbidities, and procedural characteristics, odds for 1-year mortality (odds ratio, 1.04; 95% CI, 0.90-1.19) were not different between black and whitepatients. There were also no differences in secondary outcomes with the exception of a higher rate of adjusted 30-day acute kidney injury (odds ratio, 1.22; 95% CI, 1.10-1.36). Conclusions and Relevance: While black patients had a higher rate of mortality than whitepatients in unadjusted analyses, race was not independently associated with 1-year mortality among patients undergoing PCI in VA hospitals.
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