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Racial/ethnic differences persist in treatment choice and outcomes in isolated intervention for coronary artery

Rodrigo Zea-Vera1, Sainath Asokan2, Rohan M Shah1

  • 1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.

The Journal of Thoracic and Cardiovascular Surgery
|March 6, 2022
PubMed

Insights

Racial disparities exist in coronary artery disease interventions. African American patients were less likely to receive coronary artery bypass grafting and experienced worse outcomes, highlighting a need for further investigation into these disparities.

Area of Science:

  • Cardiovascular Medicine
  • Health Services Research
  • Health Disparities

Background:

  • Racial and ethnic disparities in cardiovascular disease intervention strategies are a significant concern.
  • Understanding treatment patterns and outcomes across different racial/ethnic groups is crucial for addressing inequities.

Purpose of the Study:

  • To investigate trends and outcomes of coronary artery disease (CAD) treatment choices, specifically coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI).
  • To analyze these trends stratified by race/ethnicity using a large national inpatient database.

Main Methods:

  • A retrospective analysis of the National Inpatient Sample (NIS) database from 2002 to 2017.
  • Inclusion of patients undergoing isolated CABG or PCI, with outcomes stratified by race/ethnicity (White, African American, Hispanic, Asian).
  • Multivariable logistic regression was used to assess associations between race/ethnicity and treatment choice, in-hospital mortality, and costs, adjusting for confounders.

Main Results:

  • Over 9.6 million procedures were analyzed. African American patients, compared to White patients, were younger, had higher rates of Medicaid insurance, and more comorbidities.
  • After risk adjustment, African Americans were significantly less likely to undergo CABG (OR, 0.76) and had higher risk-adjusted mortality after CABG (OR, 1.09).
  • No significant difference in mortality was observed after PCI. African Americans incurred higher hospitalization costs for both CABG and PCI.

Conclusions:

  • Significant racial/ethnic differences exist in the utilization and outcomes of coronary artery disease interventions.
  • African American patients face lower odds of receiving CABG and experience worse outcomes, alongside higher costs.
  • Further research is essential to elucidate the reasons behind these disparities and to develop strategies for equitable care.
Abstract

Keywords:
coronary artery bypassethnicityischemic heart diseaseoutcomespercutaneous coronary interventionsrace

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