Death, hospital readmission more likely for Black patients after coronary stenting

Social determinants of health in the outpatient setting played a key role in the disparity, the study finds.

5:00 AM

Author | Noah Fromson

older man medical exam chest
Getty Images

Black patients who undergo minimally invasive procedures for clogged arteries are more likely to die or be readmitted to the hospital months after the procedure, a Michigan Medicine study finds.

The research team analyzed more than 29,000 older patients with Medicare insurance who underwent percutaneous coronary intervention, which includes stenting and balloon angioplasty, between 2013 and early 2018 using data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. They found that Black patients were 1.62 times more likely to be readmitted to the hospital within 90 days of discharge after the procedure and were 1.45 times more likely to die in long-term follow-up when adjusting for age and gender.

SEE ALSO: Marijuana use associated with higher stroke, bleeding risks after heart procedures (

"We've known that there are broad racial disparities that exist in cardiovascular disease, with Black patients less likely to undergo coronary intervention or invasive angiography, but there is a lack of data on the long-term outcomes for these patients after coronary stenting procedure," said Stephanie Spehar, M.D., first author of the study and chief medical resident in the University of Michigan Health Department of Internal Medicine.

Like Podcasts? Add the Michigan Medicine News Break on Spotify, Apple Podcasts or anywhere you listen to podcasts.

"We have seen efforts nationwide to improve the care quality of coronary stenting, particularly during the procedure, and current studies including ours show generally similar in-hospital outcomes for Black and white patients," Spehar said. "However, our findings show a concerning disparity in outcomes after patients leave the hospital."

The results, published in the American Heart Journal, reveal that social determinants of health – including community economic well-being, personal income and wealth, and preexisting health conditions – played a significant role in the outcomes.

"Our findings demonstrate that these disparities may be, at least in part, explained by multiple complex factors including social determinants of health," said senior author Devraj Sukul, M.D., M.S., interventional cardiologist at the U-M Health Frankel Cardiovascular Center and a clinical assistant professor of cardiology at U-M Medical School.

"Moreover, focusing on understanding and potentially addressing these disparities in both the peri-procedural and post-procedural settings is critically important," Sukul said. "All of these factors, such as wealth, community economic stress and comorbidities, are interconnected and accumulate over time. Lower socioeconomic status can potentially lead to worse health status, just as illness may undermine financial security and economic opportunity. Preventative action must be taken to address the complex social, environmental and behavioral factors that contribute to these outcomes."

SEE ALSO: Helping hearts across Michigan (

Percutaneous coronary intervention is performed both for patients coming in with emergent situations, such as a heart attack, as well as those experiencing chest pressure with exertion or chest discomfort. It is one of the most common cardiovascular procedures performed in the United States, with more than 635,000 procedures completed in 2017.

In addition to the long-term disparities uncovered in the study, 75% of white patients were referred for cardiac rehabilitation, compared with 58.5% of Black patients. Researchers say the findings highlight a need to reduce such disparities at the time of discharge after PCI, which will take a multi-faceted effort.

"We need policies to reinforce and expand programs that have been developed to reduce the burden of cardiovascular conditions, like hypertension and diabetes, in minority groups," Spehar said. "Clinicians can also partner with social services to address issues such as transportation and copays, trying to eliminate financial barriers to care. And cardiovascular providers must prioritize ongoing cultural competence and implicit bias training."

Additional authors include Milan Seth, M.S., Peter Henke, M.D., John Syrjamaki, M.P.H., Hitinder Gurm, M.D., all of Michigan Medicine, Khaldoon Alaswad, M.D., David Nerenz, Ph.D., both of Henry Ford Health System, Theodore Schreiber, M.D. Ascension Macomb-Oakland Hospital, Aaron Berman, M.D., Beaumont Hospital, Omar E. Ali, M.D., Detroit Medical Center Heart Hospital, Yousef Bader, M.D., McLaren Bay Regional Heart and Vascular.

Funding/disclosures: Support for BMC2 is provided by Blue Cross and Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program. Although Blue Cross Blue Shield of Michigan and BMC2 work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees.

Paper cited: "Race and Outcomes after Percutaneous Coronary Intervention: Insights from the Michigan Blue Cross Blue Shield Cardiovascular Consortium," American Heart Journal. DOI: 0.1016/j.ahj.2022.10.001

Live your healthiest life: Get tips from top experts weekly. Subscribe to the Michigan Health blog newsletter

Headlines from the frontlines: The power of scientific discovery harnessed and delivered to your inbox every week. Subscribe to the Michigan Health Lab blog newsletter

More Articles About: Lab Report Heart disease Cardiac Rehabilitation Interventional cardiology Race and Ethnicity Cardiovascular: Diseases & Conditions
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories man smiling sitting
Health Lab
A unique collaboration helps one patient better manage aortic disease
MI-AORTA is a donor-funded initiative that facilitates collaboration within the Frankel Cardiovascular Center, U-M Health and referring provider networks, creating value for the patients, families, and communities they serve and allows them to continue to pioneer advanced therapies for aortic diseases.
man standing
Health Lab
Beating the odds against chronic total occlusion
Learn about the latest advances in treatment for chronic total occlusion, a life-threatening condition that deprives the heart of oxygen. A team of cardiovascular surgeons perform advanced, minimally invasive surgery to help David Schneider get his life back on track.
Health Lab
Pulmonary embolism deaths, disparities high despite advancements in care
Despite these innovations, a Michigan Medicine study finds that the death rate for pulmonary embolism remains high and unchanged in recent years – more often killing men, Black patients and those from rural areas. The results are published in the Annals of the American Thoracic Society.
sleeping kids purple teal orange pink
Health Lab
Sleep apnea disparities in kids: Obesity may override impact of race, socioeconomics
As researchers explored potential reasons behind racial disparities in treatment outcomes for children with severe sleep apnea, they were expecting to find the answer in socioeconomic factors. But they were surprised to learn that when one risk factor – obesity – was taken out of the equation, race was no longer associated with worse post-surgery outcomes for obstructive sleep apnea.
hospital staff emergency room patient rush
Health Lab
Nearly three-quarters of stroke patients requiring higher level of care wait over two hours for transfer
More than 70% of people experiencing a stroke who require a transfer wait longer than two hours to be transferred from the initial emergency department to hospitals with higher levels of care to receive time-sensitive care, a study finds.
cartoon of hospital workers and patient
Health Lab
Children who suffer cardiac arrest more likely to survive at ECMO capable hospitals
Children who experience cardiac arrest are one and a half times more likely to survive at a hospital capable of providing the life support system called ECMO, research suggests. But the reason behind better outcomes may have less to do with being saved by the heart and lung support machine itself and more to do with the care team structure at hospitals capable of ECM0, suggests the findings in Resuscitation.