TCT-323 Is There a Difference in the Types of Complex High-Risk but Indicated Percutaneous Coronary Interventions (CHIP) Undertaken and Their Outcomes Among Different Racial Groups? Insights From a National Cohort

Abstract

Background In contemporary practice, complex high-risk but indicated percutaneous coronary intervention (CHIP) is increasingly common. Data on race-based differences in the nature of CHIP and their clinical outcomes in patients with stable coronary artery disease (CAD) are limited. Methods We obtained data on percutaneous coronary intervention (PCI) for stable CAD performed in England and Wales from January 1, 2006, to December 31, 2017, from the British Cardiovascular Intervention Society (BCIS) registry. The collected data were retrospectively analyzed and stratified by race. Multivariate regression analysis was performed to assess the relationship between CHIP, race, and outcomes. Results Of a total of 424,290 procedure records in the BCIS registry, 105,949 (24.97%) were CHIP; 89,038 (84%) were performed in White and 16,911 (16%) in Black, Asian, and minority ethnic (BAME) patients (Figure 1). BAME patients were younger (median: 68.1 years vs 70.6 years). A previous coronary artery bypass graft was the commonest CHIP factor in both White and BAME patients (33.4% vs 38.3%, respectively; P < 0.001) followed by chronic total occlusion (CTO) PCI (31.9% vs 32%, respectively; P = 0.769). The third common CHIP factor was age above 80 (23.6%) in the Whites and severe vessel calcification in BAME patients (18.8%). BAME patients had significantly higher rates of diabetes (41.1% vs 23.6%, respectively; P < 0.001), hypertension (68% vs 66.5%, P < 0.001), previous PCI (43.7% vs 37.6%, P < 0.001), and previous myocardial infarction (44.9% vs 42.5%, P < 0.001) compared with White patients. Mortality (adjusted odds ratio [aOR]: 1.07; 95% confidence interval [CI]: 0.8-1.5; P = 0.659) and major adverse cardiovascular and cerebral event (MACCE) (aOR: 0.9; 95% CI: 0.8-1.1; P = 0.564) risks were similar among races, although the bleeding risk (aOR: 0.69; 95% CI: 0.6-0.9; P = 0.002) was lower.