This study aimed to assess the short- and long-term outcomes of black and white patients undergoing newer modalities of coronary intervention. Data were drawn from the New Approaches to Coronary Interventions (NACI) registry, which is a multicenter, prospective registry of patients receiving a first treatment with one or more of seven specified new devices. The devices were directional coronary atherectomy, rotational atherectomy, transluminal extraction atherectomy, Palmaz-Schatz stent, Gianturco-Rubin stent, Advanced Interventional Systems excimer laser, and Spectranetics excimer laser. A total of 39 sites enrolled patients from August 1990 through March 1994. Patients were contacted for follow-up at six weeks, six months, and 1 year (96% of the patients had 1 year data). The sample included 4,079 whites and 200 blacks.

There were significant racial differences in demographic and baseline clinical characteristics. Blacks were younger, more obese, and more likely to have hypertension, diabetes, and congestive heart failure. There were no differences in smoking, anginal status, or recent myocardial infarction. Fewer blacks had undergone previous coronary artery bypass surgery, and blacks had CAD symptoms for a shorter duration. Black women had a higher incidence of diabetes and congestive heart failure than black men but were less likely to smoke.

New devices were used to treat 80.1% of the lesions for blacks and 83.4% of the lesions for whites. Lesions in black patients were more frequent in native vessels compared with vein grafts and were significantly less likely to be restenotic, diffuse, contain thrombus, and be tortuous or ulcerated. However, angiographic success rate was not different between these groups (91.9% of blacks versus 92.8% of whites).

With regard to new device use and procedural characteristics, blacks were less likely to have urgent or emergency procedures and were less likely to have saphenous vein grafts only. With regard to lesion treatment with new devices specifically, blacks had smaller graft vessels, tended to have less preprocedural stenosis, and had higher final stenosis. However, the overall angiographic success rate for new devices was similar (93.6% for blacks and 91.3% for whites).

Despite differences in the baseline characteristics of the groups, no significant racial difference in major in-hospital events (death, any myocardial infarction, QMI, emergency CABG, and any CABG) and procedural success rates were noted. The only sex difference noted was that the rate of myocardial infarction in black men was significantly less than the rate in black women. There were also no differences in cumulative event rates or symptomatic status at one-year follow-up between blacks and whites. However, a marked sex difference was noted again within the black population. The composite endpoint of death/QMI/any revascularization occurred in 38.4% of black men and only 28.7% of black women. There was also a sex difference among blacks in survival after discharge from a serious cardiac event. These sex differences were not apparent among whites.

The authors conclude that this study demonstrates marked differences between black and white baseline characteristics in patients undergoing percutaneous coronary interventions; however despite this finding, there were no differences in any major cardiac endpoints. This study further found sex differences in the black population and even noted a disparate relation between established risk factors and outcomes for black men and women (not presented in the results). "This unusual finding may be unique in regard to black race and sex and requires further investigation."