African American Women at Higher Risk of Revascularization, MI After PCI

By Anne Harding

May 01, 2019

NEW YORK (Reuters Health) - African American women are three times as likely as white women to have a myocardial infarction (MI) in the year following stent placement, and their risk of target vessel revascularization is almost doubled, new research shows.

The problem is likely "an issue of how are they getting cared for after they get their stent," Dr. Roxana Mehran of the Icahn School of Medicine at Mount Sinai in New York City, the study's lead author, noted in a telephone interview with Reuters Health.

"We've got to do better and in fact these women need our help because they have a lot more comorbidities," she said. "We need to take care of their risk factors, we need to take care of these women."

Women are known to be at increased risk of major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) compared to men, and some studies suggest black and Hispanic women have worse outcomes than whites, Mehran and her team note in their April 10 report in Circulation: Cardiovascular Interventions. "However, despite a rapidly growing minority population in the United States, comparisons of the clinical characteristics, angiographic features, and long-term outcomes among women of different races and ethnicities are lacking," they add.

To investigate, the authors conducted two postapproval studies of everolimus-eluting stent implantation, PLATINUM Diversity, in 1,057 women, and PROMUS ELEMENT PLUS, in 806 women. The pooled group was 76.1% white, 15.9% AA and 5.7% Hispanic/Latina. The black women were older, and black and HL women were more likely than whites to have diabetes and hypertension.

At one year, MACE occurred in 12% of black women, 11% of Hispanic patients, and 8% of whites. The differences were not significant after adjustment. However, African American women had more than triple the risk of MI compared to whites (hazard ratio 3.45) and their risk of target vessel revascularization was nearly doubled (HR 1.82).

"Clinical trials overall in cardiovascular disease are not representative of our diverse patient population who are inflicted with cardiovascular disease," Dr. Mehran said. While excluding white males allowed them to recruit a large number of female patients, she added, the percentage of non-white women remained a small minority.

Guidelines from government agencies such as the National Institute of Health call for including more women and minorities in clinical research, Dr. Mehran noted, but not much seems to have changed.

"I'm hoping we can raise enough awareness to be able to launch studies to focus on this forgotten population of patients, who are not truly well studied for any drug, device or treatment modality," she said.

"Yes, women are underrepresented, but African American and Hispanic women are really, really underrepresented, and we know nothing about them. Are they not part of our community, and should we not know more about them?"


Circ Cardiovasc Intv 2019.