Does Black Ethnicity Influence the Development of Stent Thrombosis in the Drug-Eluting Stent Era?

Collins, Sara D.; Torguson, Rebecca; Gaglia, Michael A.; Lemesle, Gilles; Syed, Asmir I.; Ben‐Dor, Itsik; Li, Yanlin; Maluenda, Gabriel; Kaneshige, Kimberly; Zhang, Xue; Kent, Kenneth M.; Pichard, Augusto D.; Suddath, William O.; Satler, Lowell F.; Waksman, Ron

doi:10.1161/circulationaha.109.907998

Cited by 47 publications

(45 citation statements)

References 33 publications

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“…In addition to these variables, physiological differences among racial and ethnic groups must also be considered as potential factors. Recently, Collins et al 6 identified black race as a significant independent risk factor for stent thrombosis with DES on multivariable analysis, despite a higher adherence to clopidogrel therapy in black patients than whites and after adjustment for socioeconomic status (HR, 2.60; 95% CI, 1.40-4.68; P<0.0023).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies comparing PCI outcomes in black and white patients have had conflicting results, [1][2][3][4][5][6] and these findings may not be applicable to patients undergoing PCI with current stent technology or to other minority populations. Randomized trials have found that drug-eluting stent (DES) use reduces repeat revascularization rates but has similar survival and myocardial infarction (MI) rates compared with bare metal stents (BMS); however, these studies were performed predominantly in white patients.…”

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confidence: 99%

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Effect of Race and Ethnicity on Outcomes With Drug-Eluting and Bare Metal Stents

et al. 2013

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We sought to evaluate long-term PCI outcomes for racial and ethnic minorities in the modern era, as well as DES use, safety, and effectiveness, using a large nationally representative patient sample. We examined data from the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims data to identify any differences in patterns of DES and BMS use among racial and ethnic groups, to describe and compare outcomes after PCI for each racial and ethnic group, and to assess comparative long-term outcomes after DES versus BMS use within each racial and ethnic group. Background

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Effect of Race and Ethnicity on Outcomes With Drug-Eluting and Bare Metal Stents

et al. 2013

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“…The studies investigate trends by race in rates of hospitalization for acute myocardial infarction over time, 27 the efficacy of quality improvement initiatives in increasing adherence to important care processes, 11 differences by race in important outcomes associated with percutaneous coronary intervention such as bleeding 28 and stent thrombosis, and the influence of home zip code on admission to highquality and revascularization hospitals. 29,30 Differences in Admitting Hospital Characteristics for Black and White Medicare Beneficiaries With Acute Myocardial Infarction Summary: Racial disparities in acute myocardial infarction (AMI) treatment may be due to differences in admitting hospitals. Little is known about factors associated with hospital selection for black and white patients with AMI.…”

Section: Myocardial Infarctionmentioning

confidence: 99%

Most Important Articles on Cardiovascular Disease Among Racial and Ethnic Minorities

Mody¹,

Gupta²,

Bikdeli³

et al. 2012

Circ: Cardiovascular Quality and Outcomes

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The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the Editor, that have published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes, and general cardiology audience. The studies included in this article represent the most significant research in the area of cardiovascular disease among racial and ethnic minorities. (Circ Cardiovasc Quality and Outcomes. 2012; 5:e33-e41.) S teady improvements have been made in the management of cardiovascular disease over the last decade.1,2 Yet, certain racial and ethnic minority groups have not experienced equivalent improvements in outcomes. For example, although the overall rate of hospitalization for heart failure has declined in recent years, decreases have been lower in blacks compared with whites. 2In addition, mortality related to stroke continues to be higher in blacks.3 There are multiple potential explanations for this heightened cardiovascular risk among minorities, including their higher prevalence of cardiovascular risk factors such as hypertension, diabetes mellitus, and obesity 4 ; the presence of genetic differences predisposing to disease 5 ; differences in socioeconomic factors relating to education, income, language proficiency, and living environments 6 ; and concerning physician attitudes, biases, or frank racism. 3,7 The Institute of Medicine defines "disparities" as "differences in health outcomes that persist when access and patient clinical factors are controlled." 8 In acknowledging the presence of these disparities experienced by racial and ethnic minorities, the American College of Cardiology (ACC) launched the Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Disease Outcomes (CREDO) alliance and the American Heart Association (AHA) issued a statement highlighting racial differences in stroke care, among other initiatives.9,10 Through these efforts, the ACC and AHA aim to improve physician awareness of racial disparities in cardiovascular disease care, conduct patient education, and provide tools to health systems to help combat inequalities.There is an urgent need for additional information regarding the pathways mediating racial disparities in cardiovascular care, especially those pathways that are amenable to interventions. We have therefore chosen to review a broad range of articles pertinent to racial and ethnic disparities in cardiovascular disease. These include papers examining racial differences in the quality of care provided for patients with myocardial infarction, 11 trends in procedure use for patients with heart failure, 12 survival after heart transplantation, 13 the relative importance of traditional and novel biomarkers of cardiovascular risk, 14 and the influence of socioeconomic factors such as living environment on outcomes. 6 We ...

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“…We read with interest the recent report by Collins et al, 1 which concludes that black race is an independent predictor of definite DES thrombosis. Although interesting, this single-center, retrospective analysis contained a relatively small number of black subjects (nϭ1594) and even fewer stent thrombosis events (nϭ108).…”

Section: To the Editormentioning

confidence: 93%

Letter by Ferdinand et al Regarding Article, “Does Black Ethnicity Influence the Development of Stent Thrombosis in the Drug-Eluting Stent Era?”

2011

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Blacks have the highest coronary heart disease mortality of major US race/ethnic groups, and represent appropriate candidacy for drug-eluting stents (DES). We read with interest the recent report by Collins et al, 1 which concludes that black race is an independent predictor of definite DES thrombosis. Although interesting, this single-center, retrospective analysis contained a relatively small number of black subjects (nϭ1594) and even fewer stent thrombosis events (nϭ108). Though provocative, these findings may still represent a play of chance, and should not yet be translated into clinical dogma. The avoidance of DES in black patients who are otherwise appropriate candidates would be yet another misstep consistent with our ongoing disparate care concerns.Because of these disparate care concerns, the American College of Cardiology launched credo (Coalition to Reduce Disparities in CV Outcomes) as an initiative to provide the tools needed to improve disparities in CV practices (www.cardiosource.org/credo). 2 These disparities are troubling and persistent; however, performance-based quality improvement, cultural competency training, team-based care, and patient education are potential interventions to reduce CVD disparities and improve outcomes.We find this report of racial differences with regard to in-stent thrombosis intriguing, less so for its findings and more so because it highlights the need for precision and sensitivity when race-based data are used. The greater prevalence of black comorbidities (eg, hypertension, diabetes mellitus, heart failure), variations in medication access and compliance, and the complexities of socioeconomic status all represent confounders that cannot be fully accommodated in any multiple regression model. Finally, self-identified, mutually exclusive race assignment is problematic. For instance, in the patient population of the current report, ie, Washington, DC, self-identified blacks include not only African Americans, but blacks of Ethiopian, Caribbean, Somalian, and Nigerian ancestry, in addition to individuals of mixed race.For these data and all ongoing race/ethnicity-based analyses, it is now imperative that we more fully understand and acknowledge the significant influence of the social determinants of health outcome; we must relinquish our enthusiasm to quickly implicate underlying race-based biological mechanisms and consider the cultural context and ecology of health in our discussions.We appreciate the efforts of the investigators to bring these data forward, but would caution all to strive for a better understanding of the underpinnings of race/ethnicity-based differences in cardiovascular care and outcomes. We should not be coerced by probability values. As practitioners responsible for the leading cause of death and disability in the United States, it is our duty to deliver the highest-quality and evidence-based care for our patients, regardless of self-identified racial/ethnic, gender, or socioeconomic status.

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Does Black Ethnicity Influence the Development of Stent Thrombosis in the Drug-Eluting Stent Era?

Abstract: Black race is an independent predictor of definite drug-eluting stent ST. Because clopidogrel compliance was higher in black patients and socioeconomic status was not associated with ST, further investigation into the potential mechanisms of this influence of race on ST must be pursued.

Cited by 47 publications

References 33 publications

Effect of Race and Ethnicity on Outcomes With Drug-Eluting and Bare Metal Stents

Effect of Race and Ethnicity on Outcomes With Drug-Eluting and Bare Metal Stents

Most Important Articles on Cardiovascular Disease Among Racial and Ethnic Minorities

Letter by Ferdinand et al Regarding Article, “Does Black Ethnicity Influence the Development of Stent Thrombosis in the Drug-Eluting Stent Era?”

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