Author + information
- Received January 18, 2019
- Revision received February 25, 2019
- Accepted March 5, 2019
- Published online May 20, 2019.
- Mohamad Alkhouli, MDa,b,∗,
- David R. Holmes Jr., MDa,∗∗ (, )
- John D. Carroll, MDc,
- Zhuokai Lid,
- Taku Inohara, MD, PhDd,
- Andrzej S. Kosinskid,
- Molly Szerlip, MDe,
- Vinod H. Thourani, MDf,
- Michael J. Mack, MDg and
- Sreekanth Vemulapalli, MDd,h
- aDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- bDivision of Cardiology, West Virginia University, Morgantown, West Virginia
- cDivision of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
- dDuke Clinical Research Institute, Durham, North Carolina
- eDepartment of Interventional Cardiology, The Heart Hospital Baylor Plano, Plano, Texas
- fDepartment of Cardiac Surgery, MedStar Heart and Vascular Institute and Georgetown University, Washington, DC
- gBaylor Scott and White Health, Dallas, Texas
- hDivision of Cardiology, Duke University School of Medicine, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. David R. Holmes, Jr., Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Objectives This study sought to evaluate racial disparities in the performance and outcomes of transcatheter aortic valve replacement (TAVR).
Background Racial disparities in cardiovascular diseases are well described. Whether the racial disparities observed in surgical aortic valve replacement also exist with TAVR remains unknown.
Methods Patients undergoing TAVR between November 2011 and June 2016 were identified in the American College of Cardiology/Society of Thoracic Surgeons/Transcatheter Valve Therapy Registry. We described the racial distribution, and the risk-adjusted in-hospital morbidity, and mortality stratified by race. We evaluated 1-year outcomes in a subset of patients via linkage to Medicare (Centers for Medicare and Medicaid Services) claims.
Results Among the 70,221 included patients, 91.3% were white, 3.8% were black, 3.4% were Hispanic, and 1.5% were of Asian/Native American/Pacific Islander race. This represented significant underrepresentation of nonwhite patients compared with their proportion of the population. After risk-adjustment, there was no difference in the rates of in-hospital mortality, myocardial infarction, stroke, major bleeding, vascular complications, or new pacemaker requirements among the 4 racial groups. Among 29,351 patients with Centers for Medicare and Medicaid Services linkage, 1-year adjusted mortality rates were similar in blacks and Hispanics compared with whites, but lower among patients of Asian/Native American/Pacific Islander race (adjusted hazard ratio: 0.71; 95% confidence interval: 0.55 to 0.92; p = 0.028). Black and Hispanic patients had more heart failure hospitalizations compared with whites (adjusted hazard ratio: 1.39; 95% confidence interval: 1.16 to 1.67; p < 0.001; and adjusted hazard ratio: 1.37; 95% confidence interval: 1.13 to 1.66; p = 0.004, respectively). These differences persisted after additional risk-adjustment for socioeconomic status.
Conclusions Racial minorities are underrepresented among patients undergoing TAVR in the United States, but their adjusted 30-day and 1-year clinical outcomes are comparable with those of white race.
↵∗ Drs. Alkhouli and Holmes contributed equally to the paper.
Funded by the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapies Registry. Dr. Carroll is an investigator in clinical trial for Edwards and Medtronic. Dr. Inohara has received a research grant from JSPS Overseas Research fellowship and Boston Scientific. Dr. Szerlip has consulted for Edwards and Medtronic. Dr. Mack is a Co-PI of Partner trial of Edwards Lifesciences, Co-PI of Coapt trial of Abbott, and study chair of Apollo trial of Medtronic. Dr. Vemulapalli received a research grant from Abbott Vascular and a research grant, consulting fees, and is an advisory board member for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 18, 2019.
- Revision received February 25, 2019.
- Accepted March 5, 2019.
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