Impact of Race on Infrainguinal Angioplasty and Stenting

Chong, Terry J.; Rowe, Vincent L.; Katz, Simon

doi:10.1016/j.avsg.2010.09.016

Cited by 11 publications

(11 citation statements)

References 11 publications

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“…In our cohort, blacks and Hispanics presented more commonly with CLI than NH whites. This has been previously demonstrated by other investigators (9, 16). We found that Hispanics were 1.5 times and blacks were almost twice as likely as NH whites to undergo major amputation in the 30-day perioperative period following endovascular treatment.…”

Section: Discussionsupporting

confidence: 87%

Racial Disparities in Outcomes of Endovascular Procedures for Peripheral Arterial Disease: An Evaluation of California Hospitals, 2005–2009

Loja¹,

Brunson²,

Li³

et al. 2015

Annals of Vascular Surgery

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Background Racial/ethnic disparities in treatment outcomes of peripheral arterial disease (PAD) are well documented. Compared to non-Hispanic (NH) whites, blacks and Hispanics are more likely to undergo amputation and less likely to undergo bypass surgery for limb salvage. Endovascular procedures are being increasingly performed as first line of therapy for PAD. In this study, we examined the outcomes of endovascular PAD treatments based on race/ethnicity in a contemporary large population-based study. Methods We used Patient Discharge Data (PDD) from California’s Office of Statewide Health Planning and Development (OSHPD) to identify all patients over the age of 35 who underwent a lower extremity arterial intervention from 2005 to 2009. A look-back period of five years was used to exclude all patients with prior lower extremity arterial revascularization procedures or major amputation. Cox proportional hazards regression was used to compare amputation-free survival and time to death within 365 days. Logistic regression was used for comparison of 1-month myocardial infarction (MI), 1-month major amputation, 1-month all-cause mortality, 12-month major amputation, 12-month reintervention, and 12-month all-cause mortality rates among NH white, black, and Hispanic patients. These analyses were adjusted for age, gender, insurance status, severity of PAD, comorbidities, history of coronary artery angioplasty or bypass surgery, or history of carotid endarterectomy. Results Between 2005 and 2009, a total of 41,507 individuals underwent PAD interventions, 25,635 (61.7%) of whom underwent endovascular procedures. There were 17,433 (68%) NH whites, 4,417 (17.2%) Hispanics, 1,979 (7.7%) blacks, 1,163 (4.5%) Asian/Native Hawaiians, and 643 (2.5%) others in this group. There was a statistically significant difference in the amputation-free survival within 365 days among the NH white, Hispanic and black groups (P < 0.0001); the hazard ratio for amputation within 365 days was 1.69 in Hispanics (95% CI 1.51–1.90; P <0.0001) and 1.68 in blacks (95% CI 1.44–1.96; P <0.001) compared to NH whites following endovascular procedures after adjusting for age, gender, insurance status, comorbidities, severity of PAD, history of coronary artery angioplasty or bypass surgery, or history of carotid endarterectomy. After adjusting for the aforementioned confounders, the first reintervention within 12 months was also significantly associated with race/ethnicity (P=0.002). Odds ratio for reintervention was 1.17 in blacks (95% CI 1.06–1.30, P=0.002) and 1.084 in Hispanics (95% CI 1.00–1.16, P=0.04) compared to NH whites. Conclusions In this contemporary large population-based study, we demonstrated that even among matched cohorts Hispanics and blacks have worse amputation-free survival than NH whites following endovascular therapy. Our study also found that Hispanics and blacks are more likely to undergo lower extremity arterial reinterventions than NH whites. Further research is crucial in understanding if higher reintervention rates in ...

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Section: Discussionsupporting

confidence: 87%

Racial Disparities in Outcomes of Endovascular Procedures for Peripheral Arterial Disease: An Evaluation of California Hospitals, 2005–2009

Loja¹,

Brunson²,

Li³

et al. 2015

Annals of Vascular Surgery

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“…These results are similar to the findings of Loja et al, 24 which, like our study, included interventions from the iliac to the infrapopliteal vessels. In contrast, Chong et al 23 limited their analysis to femoropopliteal interventions and found no difference in outcomes between AA and CAU patients. One possible explanation for the worse LS that we observed in AAs may be that there is an underlying variability in response to infrapopliteal angioplasty among different ethnic/racial groups.…”

Section: Discussionmentioning

confidence: 96%

“…[12][13][14][15] Only two studies have specifically sought to address the effect of race on infrainguinal angioplasty and stenting. Chong et al 23 conducted a single-center retrospective review that analyzed the primary patency of femoral and popliteal artery interventions according to patient race. As in our study, the AA patients had more severe disease at presentation and were more likely to have both diabetes and end-stage renal disease.…”

Section: Discussionmentioning

confidence: 99%

Poorer limb salvage in African American men with chronic limb ischemia is due to advanced clinical stage and higher anatomic complexity at presentation

Rivero

Nader

Blochle

et al. 2016

Journal of Vascular Surgery

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“…21 Furthermore, clinical trials of infrainguinal angioplasty and stenting show no significant difference in patency rates for Asian and Western pa-tients. 22 Out of 374 interventions (182 PTA, 192 PTA plus stent), there were no differences in patency rates (p¼0.12) among Asian, Caucasian, Hispanic, and African-American patients. 22 Additionally, in more complicated SFA lesions (total occlusions with mean lesion length .20 cm), the 1-year patency rates of nitinol stenting in Asian patients (72% to 92%) 23,24 compared favorably to results in Western patients with less complicated lesions (60% to 80%).…”

Section: Discussionmentioning

confidence: 91%

Two-Year Analysis of the Japanese Cohort From the Zilver PTX Randomized Controlled Trial Supports the Validity of Multinational Clinical Trials

Ohki

Yokoi²,

Kichikawa

et al. 2014

Journal of Endovascular Therapy

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Impact of Race on Infrainguinal Angioplasty and Stenting

Cited by 11 publications

References 11 publications

Racial Disparities in Outcomes of Endovascular Procedures for Peripheral Arterial Disease: An Evaluation of California Hospitals, 2005–2009

Racial Disparities in Outcomes of Endovascular Procedures for Peripheral Arterial Disease: An Evaluation of California Hospitals, 2005–2009

Poorer limb salvage in African American men with chronic limb ischemia is due to advanced clinical stage and higher anatomic complexity at presentation

Two-Year Analysis of the Japanese Cohort From the Zilver PTX Randomized Controlled Trial Supports the Validity of Multinational Clinical Trials

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