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

Abstract

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.

Determination of volatile organic compounds in exhaled breath of heart failure patients by needle trap micro-extraction coupled with gas chromatography-tandem mass spectrometry

“…HF is a complex clinical syndrome caused by a wide range of cardiovascular disorders leading to structural or functional abnormalities of the heart, and it represents a main cause of mortality and poor quality of life in the western societies [12]. According to the European Heart Failure Association, 26 million people experience HF globally and 3.6 million people are diagnosed with HF every year.…”

“…The main HF symptoms are fatigue and dyspnea, which limit exercise tolerance, and fluid retention that may lead to pulmonary and/or splanchnic congestion and/or peripheral edema. HF is a condition very often associated with poor prognosis and frequent hospital admissions [12]. Nowadays, the common clinical approaches used to diagnose and monitor HF are based on (i) clinical history and physical examination, to provide information about familial cardiac diseases and severity degree, (ii) electrolyte (e.g.…”