Racial Differences in Utilization and Outcomes for CEA and CAS: NIS Study for 2007

OBJECTIVES: To identify the presence of racial differences and outcomes after procedures for carotid disease in patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS).
METHODS: A retrospective analysis was conducted using data from Nationwide Inpatient Sample (NIS) for 2007. The NIS was queried for all patients undergoing CEA and CAS using ICD9 codes to identify these procedures. Post-operative cerebrovascular accident (CVA) and mortality were the primary endpoints in the analysis performed.
RESULTS:
In this cohort of patients from a 20% stratified sample of all U.S. hospitals for 2007, 21,429 procedures for carotid artery disease were performed. The procedure rate per 100,000 people for white patients among white patients was 6.76 for CEA and 1.21 for CAS, whereas for non-whites the rate was 3.07 for CEA and 0.59 for CAS. CEA was performed in 16,290 patients (85%) and CAS in 2,923 patients (15%) in white patients. In the non-white population CEA was performed in 1,857 patients (83%) and CAS in 359 patients (17%).
Post-operative CVA occurred in 219 patients undergoing CEA (1.09%) and 56 patient undergoing CAS (1.54%). Rate of CVA was 0.98% for whites and 1.54% for non-whites. CVA was more common in non-whites undergoing CEA with a rate of 1.62% (p< 0.05).
Of a total of 153 patients who died after carotid intervention, 110 patients died after CEA (0.55%) and 43 after CAS (1.18%). The mortality rate among white patients was 0.49% for CEA and 1.20% for CAS compared to 0.81% for CEA and 1.11% for CAS for non-whites. Mortality was significantly higher among non-whites undergoing CEA (p< 0.05).
CONCLUSIONS: There appears to be racial differences in the rate of utilization of procedures for carotid artery disease. White patients undergo procedures for carotid artery disease more frequently than non-white patients. The rate of CVA and mortality were higher in non-whites undergoing CEA. The rates of CVA and death remain higher for patients undergoing CAS as compared to CEA overall.