Repeat revascularizations are less likely in Hispanics

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NEW ORLEANS—Hispanic patients were 57 percent less likely than Caucasian patients to undergo coronary artery bypass surgery (CABG) one year after successful angioplasty. Hispanics also trended toward lower rates of overall repeat revascularization procedures including stenting and bypass surgery, according to a study presented Sunday at the American Heart Association (AHA) Scientific Sessions.

The study also found half of Hispanics undergoing PCI had diabetes. They also were more likely to have longer lesions blocking their arteries, with the average length of 15.4 mm, compared to 14.1 mm in Caucasians.

“More Hispanics have hypertension and diabetes, especially insulin-treated diabetes,” said Shailja V. Parikh, MD, from the department of internal medicine, division of cardiology at the University of Texas Southwestern Medical Center in Dallas.

The study included 542 Hispanics and 1,357 Caucasians undergoing PCI from the National Heart, Lung and Blood Institute (NHLBI) Dynamic Registry Waves from 1999 to 2006. Only clinical centers where 5 percent of patients were of Hispanic ethnicity were included.

Despite Hispanic patients being an average three years younger, researchers found more:

  • Hypertension – 80.4 versus 72.3 percent in Caucasians;
  • Diabetes – 49.2 versus 27.8 percent in Caucasians; and
  • Insulin-treated diabetes – 15 versus 7.4 percent in Caucasians.

Hispanic participants had less peripheral vascular disease (5.6 vs. 10.3 percent); prior heart attack (25.8 vs. 30.9 percent); and prior PCI (27.8 vs. 34.1 percent) than Caucasians.

Researchers found that rates of death and heart attack were similar between Hispanics and Caucasians one year after PCI.

“It's interesting that Hispanics were younger and had more risk factors," Parikh noted. “With higher rates of insulin-treated diabetes, hypertension, and longer lesion lengths, one would expect Hispanic patients to have higher rates of repeat revascularization either though CABG or PCI. However, despite having these risk factors for increased rates of restenosis, Hispanics were found to be revascularized less often after initial PCI than their Caucasian counterparts.”

“It is possible that a referral bias exists in which Hispanic patients are not being referred for coronary artery bypass surgery as commonly as Caucasians,” Parikh said. “Or, there may be mediating factors intrinsic to the Hispanic patient that could be protective toward restenosis.”

He advocated for increased preventive measures and for modification of risk factors among these patients before they reach the cath labs. Better control of the unique set of risk factors in Hispanics could decrease the need for downstream invasive interventions, according to Parikh.

Parikh and colleagues are planning to do further research on Hispanics in Dallas, where one-third of all patients undergoing cardiac catheterization at the Parkland Memorial Hospital catheterization laboratories are Hispanic.