Racial and sex disparities in resource utilization and outcomes of multi-vessel percutaneous coronary interventions (a 5-year nationwide evaluation in the United States)

Abstract

Background: There is a paucity of data regarding the racial and sex disparities in the outcomes of multivessel percutaneous coronary interventions (MVPCI).Methods: The National Inpatient Sample (NIS) was examined for the years 2010 to 2014 to incorporate adult MVPCI-related hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes. We excluded patients with the missing race or gender data from the final scrutiny. Discharge weights were used to obtain the national estimations. The principal outcomes were MVPCI-related racial and gender disparities in terms of the in-hospital mortality and complications, and diagnostic and therapeutic healthcare resource utilization. Secondary outcomes were the length of hospital stay (LOS) and hospitalization charges. We used the Chi-square test and t-test/ANOVA test to equate dichotomous and continuous variables respectively. A two-tailed P of <0.05 was considered clinically significant.Results: An estimated 769,502 MVPCI-related hospitalizations were recorded from 2010 to 2014 after excluding patients with the missing data (70,954; 8.4%). Black male and female were the youngest (62±13, 64±14 years). The highest non-elective admissions (M: 72.8%, F: 71.2%) were reported among Hispanics.Non-whites showed a higher proportion of comorbidities with lower resource utilization than whites.Hispanic males (OR 1.23) showed the highest odds of the in-hospital mortality whereas among females, Asians (OR 1.51), blacks (OR 1.35), followed by Hispanics (OR 1.22) revealed higher odds of in-hospital mortality.Odds of cardiac complications were highest amongst Asians (M: OR 1.19, F: OR 1.40). Black (6±8 days) and Hispanic (7±9 days) showed the highest length of stay among males and females respectively. Total hospitalization charges were highest among Asians. There was a greater increase in the all-cause mortality in non-whites from 2010 to 2014.Conclusions: This study determines the existence of racial disparities in resource utilization and outcomes in MVPCI. There is an instant need for interventions designed to govern these healthcare discrepancies.

Outcomes and Predictors of Mortality in Hospitalized Frail Patients Undergoing Percutaneous Coronary Intervention

“…Between varieties of different hospital admission causes, the black race has historically been associated with lower resource utilization and higher in-hospital mortality [10][11][12][20][21][22]. However, among frail patients in our study, the white race was the strongest racial predictor of inpatient mortality.…”

“…There is a high incidence of post-procedural complications in older patients undergoing cardiovascular interventions, which may be due to a higher number of comorbidities, recurrent multivessel diseases, and or disparities in resource utilization [9][10][11][12]. Moreover, frailty reduces the abilities of stress management, thereby accentuating patients' suffering [13].…”

In-Hospital Mortality Risk in Post-Percutaneous Coronary Interventions Cancer Patients: A Nationwide Analysis of 1.1 Million Heart Disease Patients

“…Current evidence of the impact of race/ethnicity in post-PCI mortality is limited. A study of 769,502 multi-vessel PCI-related hospitalizations found racial disparities with non-whites having lower resource utilization and a greater increase in all-cause mortality post-PCI than whites [ 24 ]. Another study observed that there was no impact of race/ethnicity on the incidence of acute and one-year post-PCI adverse outcomes despite differences in patient demographics, clinical presentation, angiographic characteristics, and treatment strategies [ 25 ].…”

The Impact of Atrial Fibrillation on In-Hospital Outcomes in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock Undergoing Coronary Revascularization with Percutaneous Ventricular Assist Device Support

“…Baseline demographics, hospital characteristics, medical comorbidities, and complication rates were compared between the AF+ and AF-groups. Patient-level sociodemographic and hospitallevel attributes were directly drawn out as provided, whereas the AHRQ comorbidity indicators were employed to identify on admission comorbid disorders using apposite ICD-9 CM codes as detailed earlier [13,14] . We queried the AMICS cases for in-hospital complications using the validated diagnostic codes present among the secondary diagnoses fields (Supplementary Table S1).…”