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Survival determinants in black patients with angiographically defined coronary artery disease
B E Simmons1, A Castaner, M Mar
1Department of Medicine, Morehouse School of Medicine, Atlanta, Ga.
Insights
Black patients with coronary artery disease (CAD) show lower survival rates compared to whites, especially after bypass surgery. Factors like hypertension and left ventricular hypertrophy significantly impact outcomes in this population.
Area of Science:
- Cardiology
- Public Health
- Medical Research
Background:
- Coronary artery disease (CAD) affects diverse populations with varying outcomes.
- Previous studies suggest disparities in survival rates among racial groups.
- Understanding long-term survival in Black individuals with CAD is crucial for targeted interventions.
Purpose of the Study:
- To examine the long-term survival of Black patients diagnosed with coronary artery disease (CAD) via angiography.
- To identify predictors of mortality in this specific patient cohort.
- To compare survival rates with those reported for White populations.
Main Methods:
- Analysis of 1233 consecutive Black patients undergoing cardiac catheterization.
- Collection of vital status data at a mean follow-up of 86 weeks.
- Assessment of angiographic findings, clinical factors, and echocardiographic data.
- Statistical analysis including univariate and regression models to identify mortality predictors.
Main Results:
- 41% of patients had unobstructed coronary arteries; 56% were women.
- Hypertension (82%) and left ventricular hypertrophy (68%) were highly prevalent.
- Five-year survival rates varied by disease severity: 90% (no lesions), 79% (one-vessel), and 70% (multivessel).
- Three-year survival after bypass surgery was 82% for Black patients.
- Independent predictors of mortality included angiographic variables and left ventricular hypertrophy.
Conclusions:
- Black patients with CAD exhibit lower survival rates than White patients, particularly post-bypass surgery.
- Left ventricular hypertrophy is a significant independent predictor of mortality.
- The findings highlight the need for further research into disparities and improved management strategies for Black individuals with CAD.
Abstract:
Long-term survival of blacks with angiographically defined coronary artery disease was examined in a series of 1233 consecutive patients who underwent cardiac catheterization at a large urban municipal hospital. Vital status information was available at a mean of 86 weeks for the cohort as a whole, and 94 deaths were recorded. As noted in other angiographic series that included blacks, a high proportion of patients in this study had unobstructed coronary arteries (41%), and there was a preponderance of women (56%). Hypertension was present in 82% of the cases, whereas 68% of the sample had left ventricular hypertrophy as revealed by echocardiogram. The cumulative proportion of patients who were surviving at 5 years was 90 +/- 1 (+/- SEM), 79 +/- 4, and 70 +/- 4 for patients with no obstructive lesions, one-vessel disease, and multivessel disease, respectively. The survival rate at 3 years for patients who had undergone bypass surgery (N = 152) was only 82% (+/- 5%). Noninvasive univariate predictors of mortality included male sex, history of myocardial infarction, Q waves on electrocardiogram, exercise duration on treadmill stress testing, and left ventricular hypertrophy. Angiographic predictors included left ventricular end-diastolic pressure, the number of diseased coronary vessels, ejection fraction, and mean pulmonary artery pressure. Regression analysis showed an independent association for all the angiographic variables noted previously as well as for echocardiographically determined left ventricular hypertrophy. Survival rates for blacks with coronary artery disease in this series were considerably lower than those currently reported for whites, particularly for patients who underwent coronary bypass grafting.(ABSTRACT TRUNCATED AT 250 WORDS)