African-American patients and Caucasian patients have similar one-year outcome after percutaneous coronary intervention (PCI), but chronic kidney disease (CKD) has a significant adverse effect on mortality, investigators report.
"In the hands of well trained physicians, trained to follow a predetermined series of steps in every patient, race does not matter, even in the presence of a high-risk condition such as renal failure," Dr. Paolo Raggi told Reuters Health.
Dr. Raggi and colleagues of Emory University School of Medicine in Atlanta, Georgia, assessed the effect of race on major adverse cardiovascular events (MACE), including death, at one year in 116 African-American and 800 Caucasian patients with CKD among 4372 patients referred for PCI.
African-American patients were younger and had more co-morbidities than Caucasian patients. "However, neither mortality nor MACE differed between races," Dr. Raggi and colleagues report in the June issue of the American Heart Journal.
The one-year mortality rate was 14.7 per cent in African Americans with CKD and 2.2 per cent in those without CKD; corresponding figures among Caucasians were 13.1 per cent and 3.2 per cent.
The MACE rate at one year was 31.9 per cent and 26.2 per cent in African Americans with and without CKD, respectively, and in Caucasians with and without CKD it was 31.3 per cent and 25.9 per cent, respectively.
"PCI should be performed by experienced operators and not 'fly by night,' occasional operators," Dr. Raggi emphasized.
"Furthermore, we believe that well-equipped and large referral centers may be preferable to smaller centers, especially in the presence of risk factors such as renal failure," he added. "In case something happens, experienced surgeons are at hand and nephrologists with exposure to all sorts of complications can intervene promptly."
Am Heart J 2008;155:1027-1032
