Racial Differences in Presentation and Outcomes After Peripheral Arterial Interventions: Insights From the NCDR-PVI Registry-Reference-Cited by-同舟云学术

Racial Differences in Presentation and Outcomes After Peripheral Arterial Interventions: Insights From the NCDR-PVI Registry

Published:2023-06 Issue:6 Volume:16 Page:
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Julien Howard M.¹²³⁴⁵^ORCID,Wang Yongfei⁶⁷^ORCID,Curtis Jeptha P.⁶⁷^ORCID,Johnston-Cox Hillary¹,Eberly Lauren A.¹²³⁵^ORCID,Wang Grace J.²³,Nathan Ashwin S.¹²³^ORCID,Fanaroff Alexander C.¹²³^ORCID,Khatana Sameed Ahmed M.¹²³⁴^ORCID,Groeneveld Peter W.²³⁴^ORCID,Secemsky Eric A.⁸⁹^ORCID,Eneanya Nwamaka D.¹⁰¹¹¹²,Vora Amit N.¹³^ORCID,Kobayashi Taisei¹²^ORCID,Barbery Carlos¹,Chery Godefroy¹,Kohi Maureen¹⁴,Kirksey Lee¹⁵^ORCID,Armstrong Ehrin J.¹⁶¹⁷,Jaff Michael R.¹⁸,Giri Jay²³^ORCID

Affiliation:

1. Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., H.J.-C., L.A.E., A.S.N., A.C.F., S.A.M.K., T.K., C.B., G.C., J.C.).

2. Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.G., T.K., J.G.).

3. The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (H.M.J., L.A.E., G.J.W., A.S.N., A.C.F., S.A.M.K., P.W.G., J.G.).

4. Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA (H.M.J., P.W.G., S.A.M.K.).

5. Penn Cardiovascular Center for Health Equity and Social Justice, Philadelphia (H.M.J., L.A.E.).

6. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y.W., J.P.C.).

7. Center of Outcome Research and Evaluation Yale New Haven Health System, CT (Y.W., J.P.C.).

8. Department of Medicine, Harvard Medical School, Boston, MA (E.A.S.).

9. Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A.S.).

10. Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia (N.D.E.).

11. Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia (N.D.E.).

12. Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (N.D.E.).

13. University of Pittsburgh Medical Center-Pinnacle, Wormleysburg, PA (A.N.V.).

14. Department of Radiology, University of North Carolina School of Medicine, Chapel Hill (M.K.).

15. Division of Vascular Surgery, Cleveland Clinic, OH (L.K.).

16. Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO (E.J.A.).

17. University of Colorado School of Medicine, Aurora (E.J.A.).

18. Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston (M.R.J.).

Abstract

Background: We assess the rates of device use and outcomes by race among patients undergoing lower extremity peripheral arterial intervention using the American College of Cardiology National Cardiovascular Data Registry-Peripheral Vascular Intervention (PVI) registry. Methods: Patients who underwent PVI between April 2014 and March 2019 were included. Socioeconomic status was evaluated using the Distressed Community Index score for patients’ zip codes. Multivariable logistic regression was used to assess factors associated with utilization of drug-eluting technologies, intravascular imaging, and atherectomy. Among patients with Centers for Medicare and Medicaid Services data, we compared 1-year mortality, rates of amputation, and repeat revascularizations. Results: Of 63 150 study cases, 55 719 (88.2%) were performed in White patients and 7431 (11.8%) in Black patients. Black patients were younger (67.9 versus 70.0 years), had higher rates of hypertension (94.4% versus 89.5%), diabetes (63.0% versus 46.2%), less likely to be able to walk 200 m (29.1% versus 24.8%), and higher Distressed Community Index scores (65.1 versus 50.6). Black patients were provided drug-eluting technologies at a higher rate (adjusted odds ratio, 1.14 [95% CI, 1.06–1.23]) with no difference in atherectomy (adjusted odds ratio, 0.98 [95% CI, 0.91–1.05]) or intravascular imaging (adjusted odds ratio, 1.03 [95% CI, 0.88–1.22]) use. Black patients experienced a lower rate of acute kidney injury (adjusted odds ratio, 0.79 [95% CI, 0.72–0.88]). In Centers for Medicare and Medicaid Services-linked analyses of 7429 cases (11.8%), Black patients were significantly less likely to have surgical (adjusted hazard ratio, 0.40 [95% CI, 0.17–0.96]) or repeat PVI revascularization (adjusted hazard ratio, 0.42 [95% CI, 0.30–0.59]) at 1 year compared with White patients. There was no difference in mortality (adjusted hazard ratio [0.8–1.4]) or major amputation (adjusted hazard ratio, 2.5 [95% CI, 0.8–7.6]) between Black and White patients. Conclusions: Black patients presenting for PVI were younger, had higher prevalence of comorbidities and lower socioeconomic status. After adjustment, Black patients were less likely to have surgical or repeat PVI revascularization after the index PVI procedure.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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