Association of a unique cardiovascular risk profile with outcomes in Hispanic patients referred for percutaneous coronary intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry)

Abstract

Although previous studies have demonstrated that Hispanic patients have a higher cardiovascular risk profile than Caucasians and present at a younger age for percutaneous coronary intervention (PCI), limited studies exist examining the outcomes of Hispanics after PCI and potential explanations for differences noted. Using patients from the National Heart, Lung, and Blood Institute Dynamic Registry waves 1 to 5 (1997 to 2006), demographic features, angiographic data, and 1-year outcomes of Hispanic patients (n = 542) versus Caucasian patients (n = 1,357) undergoing PCI were evaluated. Compared to Caucasians, Hispanic patients were younger and had more hypertension and diabetes mellitus, including more insulin-treated diabetes mellitus. Although mean lesion length was longer in Hispanics (15.4 vs 14.1 mm, p <0.001), there were no differences in the number of significant lesions or in the use of drug-eluting stents. At follow-up, Hispanics were more likely to report recent anginal symptoms but had a similar incidence of 1-year hospitalizations for angina. Adjusted 1-year hazard ratios for adverse events for Hispanics versus Caucasians revealed lower rates of coronary artery bypass graft surgery (hazard ratio 0.43, confidence interval 0.22 to 0.85, p = 0.02) and a trend toward lower rates of repeat revascularization (hazard ratio 0.76, confidence interval 0.57 to 1.03, p = 0.08). In conclusion, despite the presence of diabetes in almost 50% of Hispanic patients and longer lesions than in Caucasians, Hispanic patients were less likely to undergo coronary artery bypass graft surgery 1 year after PCI and had a trend toward lower rates of repeat revascularization.

Figure 1. Frequency of Revascularization Procedures in Patients Re-Hospitalized for Angina or Angina and/or MI*

MI=Myocardial Infarction, CABG=Coronary Artery Bypass Grafting, PCI=Percutaneous Coronary Intervention, Revasc=Revascularization *Angina hospitalizations: n=146 Caucasians, n=65 Hispanics Angina or MI hospitalizations: n=166 Caucasians, n=75 Hispanics

Figure 2. Adjusted One Year Hazard Ratios and Confidence Intervals for Hispanic versus Caucasian Patients

CABG=Coronary Artery Bypass Grafting, MI=Myocardial Infarction, PCI=Percutaneous Coronary Intervention, MACE=Major Adverse Cardiac Events (Death/MI/Repeat Revascularization)