Disparities among Black and White patients in plaque burden and composition and long-term impact

Rebecca Torguson; Gary S Mintz; Carlo Di Mario; Tim Ten Cate; Ziad A Ali; Varinder Singh; William Skinner; Cheng Zhang; Corey Shea; Kayode O Kuku; Hector M Garcia-Garcia; Ron Waksman

doi:10.1016/j.carrev.2023.04.023

Disparities among Black and White patients in plaque burden and composition and long-term impact

Cardiovasc Revasc Med. 2023 Oct:55:28-32. doi: 10.1016/j.carrev.2023.04.023. Epub 2023 May 1.

Authors

Affiliations

¹ The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
² Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
³ Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy.
⁴ Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands.
⁵ DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.
⁶ Department of Cardiology, Northwell Health, New York, NY, USA.
⁷ Department of Cardiology, Central Baptist Hospital, Lexington, KY, USA.
⁸ Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. Electronic address: ron.waksman@medstar.net.

PMID: 37271594
DOI: 10.1016/j.carrev.2023.04.023

Abstract

Background: Black patients presenting to the catheterization laboratory have more risk factors and worse long-term outcomes. This sub-analysis of the Lipid Rich Plaque (LRP) study quantifies the plaque burden and composition of Black vs White patients and associated outcomes.

Methods: Patients with a singular, self-reported race presenting for cardiac catheterization were enrolled if near-infrared spectroscopy/intravascular ultrasound (NIRS-IVUS) imaging of non-stented, non-culprit (NC) vessels was performed. Lipidic content was quantified at the 4-mm region with maximum Lipid Core Burden Index (maxLCBI_4mm). NC major adverse cardiac events (NC-MACE) were defined as: cardiac death, cardiac arrest, non-fatal myocardial infarction, acute coronary syndrome, revascularization, and hospital readmission for angina with >20 % disease progression through 2 years.

Results: Among 1346 patients with a singular, self-reported race, 182 were Black. Black vs White patients were more likely to be female, had higher rates of traditional risk factors, and were more likely to present acutely. Both patients and segments were more likely to have maxLCBI_4mm > 400 (46.7 % vs 30.6 %, p < 0.001, respectively; 15.5 % vs 8.9 %, p < 0.001, respectively). Vessel size and plaque burden were larger for Black vs White patients. At 2 years, maxLCBI_4mm > 400 and Black race were independently predictive of NC-MACE (hazard ratio [HR] maxLCBI_4mm > 400: 2.37 [95 % confidence interval (CI) 1.50-3.76, p < 0.001], Black race: 2.8 [95 % CI 1.27-3.42, p = 0.004], p_interaction = 0.137).

Conclusions: Compared to White patients, Black patients had more lipid-rich plaques with greater plaque burden. Both high lipidic burden and Black race were independently predictive of NC-MACE within 2 years.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT02033694, NCT02033694.

Keywords: Coronary atherosclerosis; Intravascular imaging; Lipid-rich plaque; Near-infrared spectroscopy; Racial disparities; Vulnerable plaque.

MeSH terms

Black or African American
Coronary Angiography / adverse effects
Coronary Artery Disease* / complications
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / therapy
Coronary Vessels / diagnostic imaging
Female
Humans
Lipids
Male
Myocardial Infarction* / etiology
Plaque, Atherosclerotic*
Predictive Value of Tests
Ultrasonography, Interventional / methods
White

Substances

Lipids

Associated data

ClinicalTrials.gov/NCT02033694