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African American-Caucasian American differences in aortic valve replacement in patients with severe aortic stenosis.

Publication ,  Journal Article
Yankey, GS; Jackson, LR; Marts, C; Chiswell, K; Wu, A; Ugowe, F; Wilson, J; Vemulapalli, S; Samad, Z; Thomas, KL
Published in: Am Heart J
April 2021

BACKGROUND: Among patients with severe aortic stenosis (AS), there are limited data on aortic valve replacement (AVR), reasons for nonreceipt and mortality by race. METHODS: Utilizing the Duke Echocardiography Laboratory Database, we analyzed data from 110,711 patients who underwent echocardiography at Duke University Medical Center between 1999 and 2013. We identified 1,111 patients with severe AS who met ≥1 of 3 criteria for AVR: ejection fraction ≤50%, diagnosis of heart failure, or need for coronary artery bypass surgery. Logistic regression models were used to assess the association between race, AVR and 1-year mortality. χ2 testing was used to assess potential racial differences in reasons for AVR nonreceipt. RESULTS: Among the 1,111 patients (143 AA and 968 CA) eligible for AVR, AA were more often women, had more diabetes, renal insufficiency, aortic regurgitation and left ventricular hypertrophy. CA were more often smokers, had more ischemic heart disease, hyperlipidemia and higher median income levels. There were no racial differences in surgical risk utilizing logistic euroSCORES. Relative to CA, AA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) yet similar 1-year mortality (aHR 0.81, 95% CI 0.57-1.17, P = .262). There were no significant differences in reasons for AVR nonreceipt. CONCLUSIONS: We identified 143 African Americans (AA) and 968 Caucasian Americans(CA) with severe AS who met prespecified criteria for AVR.. AA relative to CA were more often women, had more diabetes, renal insufficiency, and left ventricular hypertrophy, however had less tobacco use, ischemic heart disease, hyperlipidemia and lower median income levels. Among patients with severe AS, AA relative to CA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) without significant differences in reasons for AVR nonreceipt and similar 1-year mortality.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2021

Volume

234

Start / End Page

111 / 121

Location

United States

Related Subject Headings

  • White People
  • United States
  • Tobacco Use Disorder
  • Stroke Volume
  • Sex Factors
  • Renal Insufficiency
  • Myocardial Ischemia
  • Male
  • Logistic Models
  • Income
 

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Yankey, G. S., Jackson, L. R., Marts, C., Chiswell, K., Wu, A., Ugowe, F., … Thomas, K. L. (2021). African American-Caucasian American differences in aortic valve replacement in patients with severe aortic stenosis. Am Heart J, 234, 111–121. https://doi.org/10.1016/j.ahj.2021.01.005
Yankey, George S., Larry R. Jackson, Colin Marts, Karen Chiswell, Angie Wu, Francis Ugowe, Jimica Wilson, Sreekanth Vemulapalli, Zainab Samad, and Kevin L. Thomas. “African American-Caucasian American differences in aortic valve replacement in patients with severe aortic stenosis.Am Heart J 234 (April 2021): 111–21. https://doi.org/10.1016/j.ahj.2021.01.005.
Yankey GS, Jackson LR, Marts C, Chiswell K, Wu A, Ugowe F, et al. African American-Caucasian American differences in aortic valve replacement in patients with severe aortic stenosis. Am Heart J. 2021 Apr;234:111–21.
Yankey, George S., et al. “African American-Caucasian American differences in aortic valve replacement in patients with severe aortic stenosis.Am Heart J, vol. 234, Apr. 2021, pp. 111–21. Pubmed, doi:10.1016/j.ahj.2021.01.005.
Yankey GS, Jackson LR, Marts C, Chiswell K, Wu A, Ugowe F, Wilson J, Vemulapalli S, Samad Z, Thomas KL. African American-Caucasian American differences in aortic valve replacement in patients with severe aortic stenosis. Am Heart J. 2021 Apr;234:111–121.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2021

Volume

234

Start / End Page

111 / 121

Location

United States

Related Subject Headings

  • White People
  • United States
  • Tobacco Use Disorder
  • Stroke Volume
  • Sex Factors
  • Renal Insufficiency
  • Myocardial Ischemia
  • Male
  • Logistic Models
  • Income