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Original Investigation
September 2017

Comparative Outcomes After Percutaneous Coronary Intervention Among Black and White Patients Treated at US Veterans Affairs Hospitals

Author Affiliations
  • 1Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
  • 2Penn Cardiovascular Outcomes, Quality, and Evaluation Research Center, Philadelphia, Pennsylvania
  • 3Veterans Affairs Eastern Colorado Healthcare System, Denver
  • 4University of Colorado School of Medicine, Aurora
  • 5Colorado Cardiovascular Outcomes Research Consortium, Denver
  • 6Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora
  • 7Durham Veterans Affairs Medical Center, Durham, North Carolina
  • 8Duke University, Durham, North Carolina
  • 9Veterans Affairs North Texas Healthcare System, Dallas
  • 10University of Texas Southwestern Medical Center, Dallas
  • 11Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
  • 12University of Michigan, Ann Arbor
  • 13Veterans Affairs Boston Healthcare System, Boston, Massachusetts
  • 14Brigham and Women’s Hospital Heart & Vascular Center, Boston, Massachusetts
  • 15Harvard Medical School, Boston, Massachusetts
JAMA Cardiol. 2017;2(9):967-975. doi:10.1001/jamacardio.2017.2180
Key Points

Question  Does race affect outcomes at 1 year in patients undergoing percutaneous coronary intervention at US Veterans Affairs hospitals?

Findings  This study used data recorded in the Veterans Affairs Clinical Assessment, Reporting, and Tracking System for Cath Laboratories (CART-CL) program to study 42 391 patients undergoing percutaneous coronary intervention. There was no difference in adjusted mortality between black and white patients undergoing percutaneous coronary intervention at the Veterans Affairs hospitals at 1 year.

Meaning  Race was not independently associated with 1-year mortality among black and white patients undergoing percutaneous coronary intervention at Veterans Affairs hospitals.

Abstract

Importance  Current comparative outcomes among black and white patients treated with percutaneous coronary intervention (PCI) in the Veterans Affairs (VA) health system are not known.

Objective  To compare outcomes between black and white patients undergoing PCI in the VA health system.

Design, Setting, and Participants  This study compared black and white patients who underwent PCI between October 1, 2007, and September 30, 2013, at 63 VA hospitals using data recorded in the VA Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories (CART-CL) program. A generalized linear mixed model with a random intercept for site assessed the relative difference in odds of outcomes between black and white patients. The setting was integrated institutionalized hospital care. Excluded were all patients of other races or those with multiple listed races and those with missing data regarding race or the diagnostic cardiac catheterization. The dates of analysis were January 7, 2016, to April 17, 2017.

Exposure  Percutaneous coronary intervention at a VA hospital.

Main Outcomes and Measures  The primary outcome was 1-year mortality. Secondary outcomes were 30-day all-cause readmission rates, 30-day acute kidney injury, 30-day blood transfusion, and 1-year readmission rates for myocardial infarction. In addition, variations in procedural and postprocedural care were examined, including the use of intravascular ultrasound, optical coherence tomography, fractional flow reserve measurements, bare-metal stents, postprocedural medications, and radial access.

Results  A total of 42 391 patients (13.3% black and 98.4% male; mean [SD] age, 65.2 [9.1] years) satisfied the inclusion and exclusion criteria. In unadjusted analyses, black patients had higher rates of 1-year mortality (7.1% vs 5.9%, P < .001) as well as secondary outcomes of 30-day acute kidney injury (20.8% vs 13.8%, P < .001), 30-day blood transfusion (3.4% vs 2.7%, P < .01), and 1-year readmission rates for myocardial infarction (3.3% vs 2.7%, P = .01) compared with white patients. After adjustment for demographics, comorbidities, and procedural characteristics, odds for 1-year mortality (odds ratio, 1.04; 95% CI, 0.90-1.19) were not different between black and white patients. There were also no differences in secondary outcomes with the exception of a higher rate of adjusted 30-day acute kidney injury (odds ratio, 1.22; 95% CI, 1.10-1.36).

Conclusions and Relevance  While black patients had a higher rate of mortality than white patients in unadjusted analyses, race was not independently associated with 1-year mortality among patients undergoing PCI in VA hospitals.

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