Abstract 211: Racial Gaps in Percutaneous Coronary Intervention in Patients with End-stage Renal Disease

Abstract

Background: End-stage renal disease (ESRD) increases risk of coronary artery disease (CAD) and also worsens prognosis in CAD patients. Percutaneous coronary intervention (PCI) with stenting is an effective treatment procedure for certain categories of CAD patients. It remains unclear whether post-procedure mortality in ESRD patients is associated with patients’ race and a type of stent [[Unable to Display Character: –]] a drug-eluting stent (DES) or a bare-metal stent (BMS). Hypothesis: We hypothesized that disparities in utilization of DES and BMS stents and post-procedure mortality would exist in CAD patients with ESRD (CAD-ESRD). Methods: We conducted a retrospective cohort study of in-hospital mortality in 12,289 CAD-ESRD patients [mean + SD age: 65.4 + 11.9 years; 60.3% (7,414 of 12,289) males] after PCI with DES and BMS during 2007-2011. Patients’ race was defined as white, black, or other (Asian, Pacific Islander, Native American). Due to short length of stay, in-hospital death was defined as a binary variable (discharged alive or deceased). Multivariable logistic regression was used to obtain adjusted odds ratios (OR) for in-hospital death after DES and BMS PCI in relation to patients’ race, adjusting for clinical and demographic characteristics, including age, gender, number of stents inserted, number of vessels treated, socio-economic status, emergency department (ED) admission, rural/urban area status. Results: Crude (unadjusted) post-PCI mortality was 4.4%, with crude post-DES mortality being 3.4% and post-BMS mortality being 6.7% ( P <0.001). In the adjusted multivariable analysis, DES stents were also associated with lower mortality as compared to BMS (adjusted OR, 0.49; 95% confidence interval (CI), 0.42-0.57; P <0.001). DES stents were received by the majority of patients in all racial groups: 68.3% black, 68.9% white, and 76.9% other patients received DES. In the adjusted multivariable analysis, black patients had a borderline lower risk of post-procedure death than white patients (adjusted OR, 0.70; 95% CI, 0.49-0.99; P =0.046), while in white and other patients the risk of post-procedure death was similar (adjusted OR, 0.70; 95% CI, 0.48-1.03; P =0.072). Conclusions: Our results are indicative of the persistence of racial differences in post-PCI mortality in CAD-ESRD patients still exist, regardless of the improvements in the technique. Further studies investigating the mechanisms responsible for these disparities are warranted.