Association of Race with Long-Term Outcomes in Patients Undergoing Popliteal and Infra-Popliteal Percutaneous Peripheral Arterial Interventions.

BACKGROUND: Race-related differences in clinical features, presentation, treatment and outcomes of patients with various cardiovascular diseases have been reported in previous studies. However, the long-term outcomes in black versus white patients with popliteal and/or infra-popliteal peripheral arterial disease (PAD) undergoing percutaneous peripheral vascular interventions (PVI) are not well known. METHODS AND RESULTS: We retrospectively evaluated long-term outcomes in 696 patients (263 blacks and 433 whites) who underwent PVI for popliteal and/or infra-popliteal PAD at our institution between 2007 and 2012. When compared to white patients, black patients were younger (70 ± 11 vs. 72 ± 11; P = 0.002) and had more comorbidities: higher creatinine (2.04 ± 2.08 vs. 1.33 ± 1.16; P < 0.0001) with more ESRD (19% vs. 6%; P < 0.0001) and more diabetes (64% vs. 55%; P = 0.004). At mean follow-up of 36 ± 20 months, there was no statistically significant difference between black and white patients either in all-cause mortality (29% vs. 32%; P = 0.38) or in major amputation (4.4% vs. 4.2%; P = 0.88), respectively. In a multi-variate Cox proportional hazard model, repeat ipsilateral percutaneous revascularization or bypass were lower in black patients (HR = 0.64 [95% CI 0.46-0.89]; P = 0.007) and major adverse vascular events (MAVE) were lower in black patients as well (HR = 0.7 [95% CI 0.56-0.89]; P = 0.003). CONCLUSION: Black patients undergoing popliteal or infra-popliteal PVI had similar mortality and major amputation, but lower repeat revascularization and MAVE compared to white patients. These data support the use of PVI in minorities despite higher baseline comorbidities and call for more research to understand the mechanisms underlying the high mortality irrespective of race.

Duke Scholars

Author Rajendra H. Mehta Medicine, Cardiology