Abstract 4366450: Underrepresentation of sex and race/ethnicity in ACC/AHA/SCAI Guideline for Coronary Artery Revascularization

Abstract

Background: Despite the significant impact of race and gender on diagnosis, treatment, and outcomes in cardiovascular care, these groups remain underrepresented in the literature. To assess the inclusivity of current recommendations, we analyzed the demographic composition of studies cited in the 2021 American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) Guideline for Coronary Artery Revascularization. Research Question: What is the representation of female and racial/ethnic minority participants in the literature cited in the current revascularization guideline? Methods: Independent reviewers (R.R., R.H., P.L.L., J.S.) screened and reviewed the literature for the current coronary artery revascularization guideline, with disagreements resolved by the senior author (M.G.N.). Data collection focused on identifying studies that reported participant sex, race and ethnicity, and outcomes specific to minority populations. The analysis also assessed trends in minority representation over time, as well as socioeconomic status (SES) variables such as income, education level, marital status, and insurance coverage. Review articles, meta-analyses, and clinical guidelines were excluded from the analysis. Results: A total of 120, 588, 577 individuals were included across 715 studies, 348 (48.67%) randomized clinical trials and 367 (51.33%) observational studies. Out of the studies reviewed, 663 (92.66%) included females and 173 (24.20%) studies reported outcomes stratified by sex. Racial and/or ethnic categories were only reported in 188 (26.29%) studies: 165 (23.08%) reported White race, 112 (15.66%) Black or African American, 54 (7.55%) and 62 (8.67%) reporting Hispanic or Latino ethnicity. Just 61 of the studies (8.54%) presented race-specific outcome results. Minority representation improved over time, however, SES indicators remained underreported, with only a small number of studies capturing income, education, marital status, or insurance status. Conclusion: Although recent studies show a trend towards greater inclusion of racial and ethnic minorities, clinical studies on coronary artery revascularization still rarely provide sex or race-specific outcomes, underrepresent racial minorities, and often overlook socioeconomic factors. This limits inclusivity and generalizability of guideline recommendations, underscoring the need for more representative research and policymaking.