Clinical Outcomes After Percutaneous Coronary Intervention for Left Main Coronary Artery Disease in Patients of Diverse Race/Ethnicity.

Abstract

Data on percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease in patients of diverse race/ethnicity are scant. This study aimed to assess the impact of race/ethnicity on clinical outcomes at 12-month follow-up of patients with LMCA disease who underwent PCI with drug-eluting stent implantation. All patients who underwent PCI for LMCA disease between 2010 and 2019 at a tertiary care center were prospectively enrolled. Clinical outcomes were assessed per each race/ethnic group. The primary end point was the composite of all-cause death, myocardial infarction, or stroke at 12 months. A total of 774 consecutive patients with known race/ethnicity were prospectively enrolled (62.1% [n = 481] Caucasian, 17.2% [n = 133] Hispanic, 12.7% [n = 98] Asian, and 8.0% [n = 62] African-American). Compared with Caucasians, the hazard rate of the primary end point tended to be lower in Asian patients (6.1% vs 14.2%; hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.16 to 1.03) and similar in African-American (13.7% vs 14.2%; HR 0.93, 95% CI 0.40 to 2.16) and Hispanic patients (14.2% vs 14.2%; HR 1.02, 95% CI 0.58 to 1.78). Hazard rates of target vessel or lesion revascularization were comparable among the 4 groups. Cox multivariable regression adjustment confirmed consistent findings and revealed higher hazard rates of postdischarge bleeding in African-Americans compared with Caucasians (HR 5.89, 95% CI 1.00 to 34.5). In conclusion, within a racially/ethnically diverse cohort of patients who underwent PCI for LMCA disease, when compared with Caucasians, Asians had lower risk of all-cause death, myocardial infarction, or stroke, whereas African-Americans had increased risk of postdischarge bleeding. Condensed abstract Evidence on percutaneous coronary intervention for left main coronary artery disease in patients of diverse race/ethnicity is limited. Among 774 consecutively enrolled patients from diverse racial/ethnic backgrounds, Asians tended to experience a lower hazard for all-cause death, myocardial infarction, or stroke compared with Caucasians. A higher hazard rate of postdischarge bleeding was observed in African-Americans compared with Caucasians. Further dedicated prospective studies enrolling racial/ethnic minorities are needed to confirm the presence of effect modification in clinical outcomes based on racial/ethnic background.What is knownWhat the study adds.