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The Racial Paradox in Multiarterial Conduit Utilization for Coronary Artery Bypass Grafting
W Brent Keeling1, Jose Binongo2, Michael E Halkos1
1Clinical Research Unit, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Insights
Black patients undergoing coronary artery bypass graft surgery (CABG) had similar arterial grafting rates but worse in-hospital outcomes and long-term survival compared to white patients. Further research into these disparities is crucial.
Area of Science:
- Cardiovascular Surgery
- Health Disparities
- Outcomes Research
Background:
- Established evidence indicates poorer outcomes for Black patients post-coronary artery bypass graft (CABG) surgery compared to White patients.
- Investigating racial differences in multiarterial grafting rates and their impact on postoperative outcomes is essential.
Purpose of the Study:
- To determine if multiarterial grafting rates differ between Black and White patients undergoing CABG.
- To assess if racial disparities in postoperative outcomes persist after accounting for grafting strategy.
Main Methods:
- Retrospective review of 16,379 isolated, primary CABG patients (2,810 Black, 13,569 White) from 2002-2014.
- Calculation of modified predicted risk of mortality (M-PROM) excluding race.
- Multivariable regression analyses adjusted for M-PROM to compare outcomes.
Main Results:
- Black patients had a 10% higher likelihood of receiving multiarterial grafts (adjusted for M-PROM).
- Black patients experienced worse in-hospital outcomes, including higher odds of stroke and prolonged intubation, but not in-hospital mortality.
- Among multiarterial grafting patients, Black patients had a 34% higher mortality hazard, yet showed improved long-term survival with multiarterial vs. single grafting.
Conclusions:
- Despite similar arterial grafting rates, Black patients faced significantly worse late survival post-CABG compared to White patients.
- Racial disparities in CABG outcomes warrant continued investigation into underlying causes.
Background:
It has been established that outcomes for black patients undergoing coronary artery bypass graft surgery (CABG) are inferior to those of their white counterparts. The purpose of this study was to determine (1) whether rates of multiarterial grafting are different among black patients and white patients, and (2) whether racial differences exist in postoperative outcomes after accounting for grafting strategy.
Methods:
A retrospective review of black patients (n = 2,810) and white patients (n = 13,569) who underwent isolated, primary CABG from January 2002 to June 2014 at a US academic institution was performed. A modified predicted risk of mortality (M-PROM) score was calculated for each patient using all The Society of Thoracic Surgeons variables for CABG excluding race. Multivariable linear, logistic, and Cox regression analyses were used to assess between-group differences, adjusted for M-PROM.
Results:
Overall, 16,379 patients underwent CABG, and 2,441 (14.9%) received more than one arterial graft. When adjusted for M-PROM, the odds of blacks undergoing multiarterial CABG were 10% greater than for whites (p = 0.05). Blacks had worse inhospital outcomes, including higher odds of stroke (odds ratio 2.41, 95% confidence interval [CI]: 1.80 to 3.25) and prolonged intubation (odds ratio 2.01, 95% CI: 1.77 to 2.28). The increase in postoperative complications did not translate to a difference in inhospital mortality (p = 0.10) between racial cohorts. Moreover, among patients who underwent multiarterial grafting strategies, blacks had a hazard of mortality that was 34% higher (95% CI: 22% to 51%)) than that of their white counterparts. Among black patients, those who underwent multiarterial grafting strategies showed better long-term survival than those undergoing single grafting strategies (hazard ratio 0.86, 95% CI: 0.78 to 0.96).
Conclusions:
Despite similar rates of arterial grafting for black patients and white patients in this large single-center cohort, black patients continued to have significantly worse late survival when compared with white patients. Continued evaluation as to the causes of this disparity is warranted.
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