Black-white differences in severity of coronary artery disease among individuals with acute coronary syndromes
Jeff Whittle1, Joseph Conigliaro, C Bernie Good
1Section of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pa, USA. jwhittle@kumc.edu
Insights
Black veterans with acute coronary syndromes were less likely than white veterans to have significant coronary artery obstruction. This racial difference in coronary obstructive disease was observed despite controlling for risk factors.
Area of Science:
- Cardiology
- Vascular Medicine
- Health Disparities
Background:
- Coronary artery disease (CAD) is a leading cause of mortality globally.
- Understanding racial and ethnic differences in CAD presentation and severity is crucial for targeted interventions.
- Acute coronary syndromes (ACS) represent a spectrum of clinical conditions including acute myocardial infarction (AMI) and unstable angina (UnA).
Purpose of the Study:
- To investigate potential racial disparities in the extent of coronary obstructive disease among black and white patients diagnosed with acute coronary syndromes.
- To compare the prevalence and severity of coronary artery obstructions between black and white veterans presenting with ACS.
- To identify if observed differences are attributable to known risk factors for coronary artery disease.
Main Methods:
- Retrospective chart review of administrative discharge data from Department of Veterans Affairs (VA) hospitals.
- Inclusion criteria: male patients aged 30 years or older, diagnosed with AMI or UnA, and who underwent coronary angiography.
- Exclusion criteria: patients not meeting clinical criteria for AMI/UnA, or with prior revascularization procedures.
Main Results:
- Among patients with AMI, black veterans had a significantly lower likelihood of significant coronary obstructions (19%) compared to white veterans (7%).
- Similarly, black veterans with UnA were more likely to have no significant stenoses (33%) than white veterans (17%).
- No racial differences were found in the severity of coronary disease among veterans with at least one significant obstruction, and these differences persisted after adjusting for risk factors.
Conclusions:
- Black veterans presenting with acute coronary insufficiency demonstrate a reduced likelihood of significant coronary obstruction compared to white veterans.
- The underlying mechanisms driving these observed racial differences in coronary obstructive disease remain unexplained by current medical understanding.
- Further research is warranted to elucidate the factors contributing to these disparities in cardiovascular disease presentation.
Objective:
To determine whether the extent of coronary obstructive disease is similar among black and white patients with acute coronary syndromes.
Design:
Retrospective chart review.
Patients:
We used administrative discharge data to identify white and black male patients, 30 years of age or older, who were discharged between October 1, 1989 and September 30, 1995 from 1 of 6 Department of Veterans Affairs (VA) hospitals with a primary diagnosis of acute myocardial infarction (AMI) or unstable angina (UnA) and who underwent coronary angiography during the admission. We excluded patients if they did not meet standard clinical criteria for AMI or UnA or if they had had prior percutaneous transluminal coronary angioplasty or coronary artery bypass grafting.
Measurements And Main Results:
Physician reviewers classified the degree of coronary obstruction from blinded coronary angiography reports. Obstruction was considered significant if there was at least 50% obstruction of the left main coronary artery, or if there was 70% obstruction in 1 of the 3 major epicardial vessels or their main branches. Of the 628 eligible patients, 300 (48%) had AMI. Among patients with AMI, blacks were more likely than whites to have no significant coronary obstructions (28/145, or 19%, vs 10/155 or 7%, P =.001). Similarly, among patients with UnA, 33% (56/168) of blacks but just 17% (27/160) of whites had no significant stenoses (P =.012). There were no racial differences in severity of coronary disease among veterans with at least 1 significant obstruction. Racial differences in coronary obstructions remained after correcting for coronary disease risk factors and characteristics of the AMI.
Conclusions:
Black veterans who present with acute coronary insufficiency are less likely than whites to have significant coronary obstruction. Current understanding of coronary disease does not provide an explanation for these differences.
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