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

Kumar, Robert; Douglas, Pamela S.; Peterson, Eric D.; Anstrom, Kevin J.; Dai, David; Brennan, J. Matthew; Hui, Peter; Booth, Michael; Messenger, John C.; Shaw, Richard E.

doi:10.1161/circulationaha.113.001437

Cited by 57 publications

(41 citation statements)

References 26 publications

(46 reference statements)

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“…9,[55][56][57] Although East Asian patients have a higher prevalence of high on-treatment platelet reactivity during clopidogrel treatment than white patients, 9,51 the incidence of adverse ischaemic outcomes or stent thrombosis after PCI is similar or lower than that in white patients. [58][59][60][61] Analysis of data from the US National Cardiovascular Data Registry showed that Asian patients undergoing coronary stent implantation had a lower adjusted risk for the compo site end point of death, MI, and repeat revascularization than white patients (HR 0.89, 95% CI 0.82-0.96, P value not given). 58 In this analysis, the individual end point of death was slightly lower in Asian patients than in white patients, and the incidence of MI was similar in each group.…”

Section: Consensus Statementsmentioning

confidence: 99%

“…[58][59][60][61] Analysis of data from the US National Cardiovascular Data Registry showed that Asian patients undergoing coronary stent implantation had a lower adjusted risk for the compo site end point of death, MI, and repeat revascularization than white patients (HR 0.89, 95% CI 0.82-0.96, P value not given). 58 In this analysis, the individual end point of death was slightly lower in Asian patients than in white patients, and the incidence of MI was similar in each group. The incidence of stent thrombosis reported in South Korean and Japanese registries (~0.2% per year) is lower than that in Western registries (~0.6% per year) after first-generatio n drugeluting stent implantation.…”

Section: Consensus Statementsmentioning

confidence: 99%

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World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2014

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| Guideline recommendations on the use of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention (PCI) have been formulated by both the ACC/AHA and the ESC. These recommendations are based primarily on large, phase III, randomized, controlled trials of the P2Y 12 inhibitors clopidogrel, prasugrel, and ticagrelor. However, few East Asian patients have been included in the trials to assess the use of these agents, particularly the newer agents prasugrel and ticagrelor. Additionally, an increasing body of data suggests that East Asian patients have differing risk profiles for both thrombophilia and bleeding compared with white patients, and that a different 'therapeutic window' of on-treatment platelet reactivity might be appropriate in East Asian patients. Furthermore, a phenomenon referred to as the 'East Asian paradox' has been described, in which East Asian patients have a similar or even a lower rate of ischaemic events after PCI compared with white patients, despite a higher level of platelet reactivity during DAPT. Recognizing these concerns, the World Heart Federation has undertaken this evidence-based review and produced this expert consensus statement to determine the antiplatelet treatment strategies that are most appropriate for East Asian patients.

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Section: Consensus Statementsmentioning

confidence: 99%

Section: Consensus Statementsmentioning

confidence: 99%

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2014

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“…12 The lack of appropriate use of evidence-based therapies after PCI may partially contribute to the excess morbidity and mortality reported among minorities. 13,14,6 The improvement of medication adherence is a global priority, 15 yet only a few experimental interventions have been proven to be successful. 16 These include interventions that reduce out-of-pocket costs, simplify regimens, facilitate delivery of medications, or offer behavioral support.…”

Section: Introductionmentioning

confidence: 99%

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

et al. 2014

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BACKGROUND:Minorities have lower adherence to cardiovascular medications and have worst cardiovascular outcomes post coronary stent placement OBJECTIVE: The aim of this study is to compare the efficacy of phone-delivered Motivational Interviewing (MINT) to an educational video at improving adherence to antiplatelet medications among insured minorities. DESIGN: This was a randomized study. PARTICIPANTS: We identified minorities with a recently placed coronary stent from an administrative data set by using a previously validated algorithm. INTERVENTIONS: MINT subjects received quarterly phone calls and the DVD group received a one-time mailed video. MAIN MEASURES: Outcome variables were collected at baseline and at 12-month post-stent, using surveys and administrative data. The primary outcome was antiplatelet (clopidogrel and prasugrel) adherence measured by Medication Possession Ratio (MPR) and self-reported adherence (Morisky score). We also measured appropriate adherence defined as an MPR ≥ 0.80. KEY RESULTS: We recruited 452 minority subjects with a new coronary stent (44 % Hispanics and 56 % Black). The patients had a mean age of 69.5±8.8, 58 % were males, 78 % had an income lower than $30,000 per year and only 22 % had achieved high school education or higher. The MPR for antiplatelet medications was 0.77 for the MINT group compared to 0.70 for the DVD group (p<0.05). The percentage of subjects with adequate adherence to their antiplatelet medication was 64 % in the MINT group and 50 % in the DVD group (p<0.01). Self-reported adherence at 12 months was higher in the MINT group compared to the DVD group (p<0.01). Results were similar among drug-eluting stent (DES) recipients. CONCLUSIONS: Among racial minorities, a phone-based motivational interview is effective at improving adherence to antiplatelet medications post coronary stent placement. Phone-based MINT seems to be a promising and cost-effective strategy to modify risk behaviors among minority populations at high cardiovascular risk. BACKGROUNDThe safe use of coronary stents requires the daily use of thienopyridines for 3 to 12 months after percutaneous coronary intervention (PCI). 1 The premature discontinuation of these medications 1 is associated with an increased risk of instent thrombosis, cardiovascular events and death. 2-6 Unfortunately, lack of medication adherence is common and is associated with significant health care costs and mortality. 7,8 Vulnerable groups such as racial minorities and the elderly have a higher risk of poor adherence. 5,6,9,10 In the case of antiplateletet medications, blacks are more likely to not receive a clopidogrel prescription 11 or to not fill it after PCI. Further, our prior analyses of insurer claims data showed that minority populations were less adherent to antiplatelet medications post drug-eluting stent (DES) placement. 12 The lack of appropriate use of evidence-based therapies after PCI may partially contribute to the excess morbidity and mortality reported among minorities. 13,14,6 The improvement of med...

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“…The finding that African-American patients are less likely to receive DES than Caucasians has been observed in prior studies. [67813] However, our study shows that when insurance is uniform, DES utilization is similar in African-American and Caucasian predominant areas. This could be due to similar utilization of DES in Caucasian and African-American HRRs despite variation in prevalence of comorbid conditions and socioeconomic milieu or an underutilization of DES in African-American dominant HRRs compared to Caucasian HRRs.…”

Section: Discussionmentioning

confidence: 64%

Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort

et al. 2017

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Objective:Insurance status is a predictor of drug-eluting stent (DES) usage. Our study sought to determine the effect of hospital and sociodemographic characteristics on utilization of DES in nationwide inpatient discharges with uniform insurance (Medicare).Methods:We linked data from the 2011 to 2012 Medicare discharges, 2011 Medicare hospital referral region (HRR) report (racial composition of each HRR), American Hospital Association (number of beds, rural/urban location, public/private status, and academic affiliation of hospitals), and American Community Survey 2011 (median income using zip code). We analyzed diagnosis-related group (DRG) codes 249 (bare metal stent without complications), 246, and 247 (DES with and without complications, respectively). Univariate and multivariable logistic regression was conducted to determine odds ratios (OR) for utilization of DES.Results:There were 322,002 discharges with DRG codes 246 (54,279), 247 (209,365), and 249 (58,358) in our database. Higher odds of DES usage was observed in Hispanic dominant HRR(s) (OR: 1.37, 95% confidence interval [CI]: 1.33–1.42, P < 0.001) compared to Caucasian dominant HRR(s). DES utilization was similar in African-American and Caucasian dominant HRR (s). Higher odds of DES use was observed in median household income groups ≥$20,001 (OR: 1.07, 95% CI: 1.01–1.13, P - 0.03). Lower DES usage was observed in hospitals with higher total stent volume (quartile 4 vs. quartile 1: OR: 0.66, 95% CI: 0.63–0.69, P < 0.001) and for-profit hospitals (OR: 0.88, 95% CI: 0.85–0.92, P < 0.001).Conclusions:Our study findings suggest that there are significant differences in DES utilization in a national cohort of individuals with uniform insurance.

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

Cited by 57 publications

References 26 publications

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort

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