Journal article
Outcomes in Women and Minorities Compared With White Men 1 Year After Everolimus-Eluting Stent Implantation: Insights and Results From the PLATINUM Diversity and PROMUS Element Plus Post-Approval Study Pooled Analysis
JAMA cardiology, Vol.2(12), pp.1303-1313
12/01/2017
DOI: 10.1001/jamacardio.2017.3802
PMCID: PMC5814993
PMID: 29049508
Abstract
There exist limited outcomes data for women and minorities after contemporary percutaneous coronary intervention (PCI).
To examine 1-year outcomes in women and minorities vs white men after PCI with everolimus-eluting stents.
The PLATINUM Diversity study was a single-arm study enrolling women and minorities. Patient-level pooling with the PROMUS Element Plus Post-Approval Study was prespecified. Data on social determinants of health and language were collected in the PLATINUM Diversity cohort, which included 1501 patients at 52 US sites. The PROMUS Element Plus Post-Approval study enrolled 2681 patients at 52 US sites with some site overlap and included an "all-comers" population. All patients were enrolled beginning in October 2014 and were followed for 12 months. Analyses began in August 2016.
Patients received 1 or more everolimus-eluting stent implantation.
The primary end point was 1-year major adverse cardiac events (MACE), which included death/myocardial infarction (MI)/target vessel revascularization. Secondary ischemic end points were also evaluated.
The pooled study consisted of 4182 patients: 1635 white men (39.1%), 1863 women (white and minority) (44.5%), and 1059 minority patients (women and men) (25.3%). Women and minorities had a higher prevalence of diabetes, prior stroke, hypertension, renal disease, and congestive heart failure than white men but lower rates of multivessel disease, prior coronary artery bypass graft surgery, prior MI, and smoking. Unadjusted 1-year MACE rates (white men, 7.6%; women, 8.6%; minorities, 9.6%) were similar between groups with no significant differences after risk adjustment. The adjusted risk of death/MI was higher among women (odds ratio, 1.6; 95% CI, 1.1-2.4) and minorities (odds ratio, 1.9; 95% CI, 1.2-2.8) compared with white men and the adjusted risk of MI was higher in minorities (odds ratio, 2.6; 95% CI, 1.4-4.8). These differences were driven primarily by nonstent-related MIs. Within the PLATINUM Diversity cohort, the independent predictors of MACE were cardiogenic shock, renal disease, history of peripheral vascular disease, multivessel disease, widowhood, and lack of private insurance.
After contemporary everolimus-eluting stent implantation, women and minorities experience a similar risk of 1-year MACE but a higher adjusted risk of recurrent ischemic events primarily because of nonstent-related MIs. Both clinical and angiographic factors and social determinants of health, including widowhood and insurance status, contribute to 1-year MACE among women and minorities.
Details
- Title: Subtitle
- Outcomes in Women and Minorities Compared With White Men 1 Year After Everolimus-Eluting Stent Implantation: Insights and Results From the PLATINUM Diversity and PROMUS Element Plus Post-Approval Study Pooled Analysis
- Creators
- Wayne Batchelor - Tallahassee, Memorial Healthcare, Tallahassee, FloridaDavid E Kandzari - Piedmont Heart Institute, Atlanta, GeorgiaScott Davis - Baptist Hospital, Little Rock, ArizonaLuis Tami - Research Physicians Network Alliance, Hollywood, FloridaJohn C Wang - MedStar Union Memorial Hospital, Baltimore, MarylandIslam Othman - North Carolina Heart and Vascular Research, RaleighOsvaldo S Gigliotti - Seton Heart Institute, Austin, TexasAmir Haghighat - Cardiovascular Institute of Northwest Florida, Panama CitySarabjeet Singh - Central Cardiology Medical Clinic, Bakersfield, CaliforniaMario Lopez - Charlotte Heart and Vascular Institute, Port Charlotte, FloridaGregory Giugliano - Baystate Medical Center, Springfield, MassachusettsPhillip A Horwitz - University of Iowa Carver College of Medicine, Iowa CityJaya Chandrasekhar - Mount Sinai Medical Center, New York, New YorkPaul Underwood - Boston Scientific Corporation, Marlborough, MassachusettsCraig A Thompson - Boston Scientific Corporation, Marlborough, MassachusettsRoxana Mehran - Mount Sinai Medical Center, New York, New York
- Resource Type
- Journal article
- Publication Details
- JAMA cardiology, Vol.2(12), pp.1303-1313
- DOI
- 10.1001/jamacardio.2017.3802
- PMID
- 29049508
- PMCID
- PMC5814993
- ISSN
- 2380-6583
- eISSN
- 2380-6591
- Language
- English
- Date published
- 12/01/2017
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984094517002771
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