Evaluating Outcomes in Very Elderly Patients Undergoing Revascularization for Stable Ischemic Heart Disease Stratified by Racial/Ethnic Group
Presenter
Derek Q. Phan, M.D., Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
Derek Q. Phan, M.D.1, Jesse Goitia, M.D.1, Ming-Sum Lee, M.D., PhD1, Brendan Kim, M.D.1, Naing A. Moore, M.D.2, Prakash W. Mansukhani, M.D.3, Vicken J. Aharonian, M.D., FSCAI3, Somjot S. Brar, M.D., FSCAI1 and Ray Zadegan, M.D.1, (1)Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, (2)-, South Pasadena, CA, (3)Kaiser Permanente, Los Angeles, CA
Keywords: Diversity Equity and Inclusion (DEI) and Quality
Background
Very elderly patients are under-represented in randomized clinical trials for stable ischemic heart disease (SIHD). We sought to evaluate if there are any racial/ethnic disparities with revascularization and outcomes within this population.
Methods
Retrospective study of patients age
>80 years with SIHD referred for invasive coronary angiography (ICA) at Kaiser Permanente Los Angeles Medical Center between April 2009 and February 2019. Patients were grouped by revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) versus medical therapy. Cox proportional hazard regression analysis was utilized to evaluate outcomes.
Results
There were 1,012 patients (average age 83.6 ± 2.9, 29% female) included. Of these, 554 (54.7%) were revascularized with PCI (41%) or CABG (13.6%). There were 114 (11.3%) Blacks, 590 (58.3%) Whites, 116 (11.5%) Asians, and 192 (19%) Hispanics. There were no differences in all-cause mortality between revascularization vs medical therapy in all racial/ethnic groups: Blacks (Hazard Ratio [HR] 0.61, 95% Confidence Interval [CI] 0.31-1.19), Hispanic (HR 0.64, 95% CI 0.39-1.06), Asians (HR 1.50, 95% CI 0.70-3.19), and Whites (HR 0.82, 95% CI 0.63-1.07). Similarly, there were no differences in non-fatal myocardial infarction (MI) between racial/ethnic groups: Blacks (HR 1.81, 95% CI 0.67-4.87), Hispanic (HR 0.84, 95% CI 0.43-1.64), Asians (HR 0.90, 95% CI 0.33-2.44), and Whites (HR 1.11, 95% CI 0.68-1.82). Amongst all those revascularized, there were no significant racial/ethnic differences in all-cause mortality or non-fatal MI outcomes.
Conclusions
In very elderly patients
>80 years of age with SIHD, there were no notable differences in all-cause mortality and non-fatal MI with revascularization between racial/ethnic groups. Further studies are needed in this high risk group to help guide management and outcomes.