Abstract 14591: Persistent Racial Disparities in Risks of Readmission and Mortality After Percutaneous Coronary Intervention in the Contemporary Era: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Abstract

Introduction: Racial disparities in the management and outcomes following acute myocardial infarction are well-established. However, there remains conflicting data on whether such disparities exist between black and non-black patients (pts) after percutaneous coronary intervention (PCI) in contemporary practice. Hypothesis: We hypothesize that compared with non-black race, black race is associated with increased risks of post-PCI readmission and mortality. Methods: We linked clinical registry data from PCIs performed between 1/2013 and 3/2018 at 48 Michigan hospitals to Medicare Fee-for-service claims. Patient race as recorded in the registry was dichotomized as black and non-black. The date of death was obtained from the Medicare beneficiary file. We used a logistic regression model to estimate the odds of 90-day readmission and a Cox model to estimate the association between race and post-discharge mortality after adjusting for important clinical characteristics. Results: A total of 30,206 pts (10.0% black, 59.9% men) were included. Black pts tended to be younger (68.9 vs 72.2 yrs), were more likely to smoke (27.7% vs. 19.5%), and had a higher burden of cardiovascular comorbidities. Compared with non-black pts, black pts had an increased risk of 90-day readmission (26.5% vs. 18.2%; adjusted OR 1.34; 95% CI 1.22-1.47; p<0.001) and long-term mortality after PCI (HR 1.13; 95% CI 1.05-1.21; p=0.001) (Figure). Conclusions: Even after accounting for clinical comorbidities, in contemporary practice black pts are at an increased risk of readmission and long-term mortality after PCI discharge. Future studies investigating differences in care and social determinants of health are needed to elucidate the mechanisms behind these disparate outcomes and identify potential opportunities to reduce these dramatic and persistent health care disparities.