Association of Black Race and PAD Presentation and Treatment Evaluated in Analysis of NCDR-PVI Registry

October 5, 2021—An analysis from the National Cardiovascular Data Registry (NCDR) Peripheral Vascular Intervention (PVI) registry investigated differences in presentation and outcomes after PVIs.

The study found that after controlling for demographic and socioeconomic factors, Black patients were younger and had higher rates of comorbidities and lower socioeconomic status. Additionally, Black patients had significantly higher rates of drug-eluting technology use but were less likely to have surgical or repeat PVI revascularization in the year after index PVI.

Howard M. Julien, MD, presented the findings from the study during a late-breaking clinical trial session at VIVA 2021, the annual Vascular InterVentional Advances meeting held October 4-7 in Las Vegas, Nevada.

As noted in a press release from the VIVA Foundation, the association between Black race and higher prevalence of peripheral artery disease (PAD) has been well established. Among PAD patients, Black race is independently associated with a greater likelihood of undergoing lower extremity amputation compared with surgical revascularization.

After accounting for sociodemographic community distress, comorbid conditions, clinical presentation, and hospital characteristics, the investigators aimed to evaluate whether the employment of drug-eluting technologies, atherectomy, and intravascular imaging during PVI procedures differed between Black and White patients in the NCDR-PVI registry.

The investigators reported that among 63,150 patient cases, Black patients were younger (67.9 vs 70.0 years), had higher rates of hypertension (94.4% vs 89.5%) and diabetes (63.0% vs 46.2%), were less likely to report being able to walk 200 meters (29.1% vs 24.8%), and had higher DCI scores (65.1 vs 50.6).

Additionally, Black patients had higher use of drug-eluting technologies (adjusted odds ratio [aOR], 1.14; 95% CI, 1.06-1.23), with no difference in atherectomy use (aOR, 0.98; 95% CI, 0.91-1.05) or intravascular imaging use (aOR, 1.03; 95% CI, 0.88-1.22).

Finally, the investigators stated that in Centers for Medicare & Medicaid Services–linked analyses of 7,429 cases (11.8%), Black patients had nonsignificantly greater adjusted hazard ratio (aHR) for major amputation (aHR, 2.50; 95% CI, 0.82-7.63) and were less likely to have surgical (aHR, 0.40; 95% CI, 0.17-0.96) or repeat PVI revascularization (aHR, 0.42; 95% CI, 0.30-0.59) at 1 year compared to White patients, according to the VIVA announcement.