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Risk of Major Adverse Cardiovascular Events and Major Hemorrhage Among White and Black Patients Undergoing Percutaneous Coronary Intervention
- Source :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Publication Year :
- 2019
- Publisher :
- John Wiley and Sons Inc., 2019.
-
Abstract
- Background Data on racial disparities in major adverse cardiovascular events ( MACE ) and major hemorrhage ( HEM ) after percutaneous coronary intervention are limited. Factors contributing to these disparities are unknown. Methods and Results PR i ME ‐GGAT (Pharmacogenomic Resource to Improve Medication Effectiveness–Genotype‐Guided Antiplatelet Therapy) is a prospective cohort. Patients aged ≥18 years undergoing percutaneous coronary intervention were enrolled and followed for up to 1 year. Racial disparities in risk of MACE and HEM were assessed using an incident rate ratio. Sequential cumulative adjustment analyses were performed to identify factors contributing to these disparities. Data from 919 patients were included in the analysis. Compared with white patients, black patients (n=203; 22.1% of the cohort) were younger and were more likely to be female, to be a smoker, and to have higher body mass index, lower socioeconomic status, higher prevalence of diabetes mellitus and moderate to severe chronic kidney disease, and presentation with acute coronary syndrome and to undergo urgent percutaneous coronary intervention. The incident rates of MACE (34.1% versus 18.2% per 100 person‐years, P HEM (17.7% versus 10.3% per 100 person‐years, P =0.02) were higher in black patients. The incident rate ratio was 1.9 (95% CI, 1.3–2.6; P MACE and 1.7 (95% CI , 1.1–2. 7; P =0.02) for HEM . After adjustment for nonclinical and clinical factors, black race was not significantly associated with outcomes. Rather, differences in socioeconomic status, comorbidities, and coronary heart disease severity were attributed to racial disparities in outcomes. Conclusions Despite receiving similar treatment, racial disparities in MACE and HEM still exist. Opportunities exist to narrow these disparities by mitigating the identified contributors.
- Subjects :
- medicine.medical_specialty
Race and Ethnicity
medicine.medical_treatment
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
medicine
Humans
030212 general & internal medicine
coronary heart disease
race
Original Research
health disparities
2. Zero hunger
White (horse)
Quality and Outcomes
business.industry
Background data
Percutaneous coronary intervention
Coronary heart disease
Health equity
3. Good health
Black or African American
Cardiovascular Diseases
Emergency medicine
outcome
Cardiology and Cardiovascular Medicine
business
Mace
Health Services and Outcomes Research
Subjects
Details
- Language :
- English
- ISSN :
- 20479980
- Volume :
- 8
- Issue :
- 22
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Accession number :
- edsair.doi.dedup.....1f9e1f1e41f742831249d6c38eef9d8e