This study analyzed the effect of black race on carotid endarterectomy (CEA) outcomes in the United States from the Vascular Quality Initiative (VQI) registry. It included 57,622 CEA patients, 2909 (5%) of whom were black. Of the 54,713 white patients, 30% were symptomatic vs 34% of black patients. Blacks had a higher vascular disease burden and were less likely to be operated on in high-volume hospitals and by high-volume surgeons. Black symptomatic patients underwent surgery more often in <2 weeks after the index neurologic event (47% vs 40%). The perioperative stroke/death rates were comparable between blacks and whites. A multivariant analysis showed that black race was not an independent risk factor for poor outcomes with a shortened survival after CEA, although many conditions were more common in blacks (eg, CEA without patch, insulin-dependent diabetes mellitus, prior stroke, lower volume surgeons and centers, and congestive heart failure were associated with poor outcomes). What is also interesting is that black patients experienced better adjusted long-term survival. Some of the findings are very interesting. Specifically, although a good percentage of the black population live in large metropolitan areas, they were less likely to be operated on by high-volume surgeons and in high-volume centers. Similarly, the authors state that symptomatic blacks were more likely to be operated on in <2 weeks vs ≥2 weeks. Can this explain why the perioperative outcomes were similar between blacks and whites who had procedures done beyond 2 weeks, since most authorities advocate surgery in <2 weeks of a neurologic event to optimize benefits of CEA? Why were blacks operated on earlier? Was it easier to convince them to proceed with surgery? Black patients also had a longer length of hospital stay and higher rate of failed discharge home, which may be explained by the extent of their vascular disease. Several studies have evaluated the impact of race on outcomes of CEA, with conflicting results. In an interesting study by Brown et al,1Brown H.A. Sullivan M.C. Gusberg R.G. Dardik A. Sosa J.A. Indes J.E. Race as a predictor of morbidity, mortality, and neurologic events after carotid endarterectomy.J Vasc Surg. 2013; 57: 1325-1330Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar data from the American College of Surgeons National Surgical Quality Improvement Program identified CEAs in 29,114 whites (96%) and 1316 blacks (4%). The stroke rate was 1.6% for whites and 2.5% for blacks (P = .009). The 30-day mortality was 0.7% for whites and 1.4% for blacks (P = .002). There was also a longer operating time and length of stay (P < .001) in blacks. A multivariant logistic regression showed black race as an independent risk factor for 30-day mortality (odds ratio, 1.9; P = .007). Blacks also had a greater proportion of in-hospital death (74% vs 43%; P = .01). Another study by Wayangankar et al2Wayangankar S.A. Kennedy K.F. Aronow H.D. Rundback J. Tafur A. Drachman D. et al.Rachial/ethnic variation in carotid artery revascularization utilization and outcomes: analysis from the National Cardiovascular Data Registry.Stroke. 2015; 46: 1525-1532Crossref PubMed Scopus (17) Google Scholar compared the utilization and outcome of carotid artery stenting and CEA across racial ethnic groups within the Carotid Artery Revascularization and Endarterectomy (CARE) registry (2007-2012). There were 10,953 patients who underwent CEA (93% white, 4% black, 3% Hispanic). There was a trend toward increased carotid artery stenting utilization among whites and increased CEA utilization among Hispanics and blacks. In-hospital major adverse cardiac and cerebrovascular events were comparable between the groups, whereas the 30-day major cardiac and cerebrovascular events were significantly higher in blacks. It is feasible that the difference between these studies and the present study can be explained by the data, which were obtained by the VQI vs the National Surgical Quality Improvement Program, which may reflect different populations and operating surgeons because the VQI data are mainly related to vascular surgeons and may not include other nonvascular surgeons who perform CEAs. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. The impact of race on outcomes after carotid endarterectomy in the United StatesJournal of Vascular SurgeryVol. 68Issue 2PreviewBlack patients undergoing carotid endarterectomy (CEA) in the United States are more often symptomatic at presentation and have more comorbidities compared with white patients. However, the impact of race on outcomes after CEA is largely unknown. Full-Text PDF Open Archive