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Adverse 5-year outcome after coronary artery bypass surgery in blacks
1Department of Cardiothoracic Surgery and Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, Calif, USA.
Insights
Black patients had significantly worse survival outcomes after coronary artery bypass surgery compared to white patients. This disparity persisted even after accounting for medical risk factors and insurance status.
Area of Science:
- Cardiovascular Surgery
- Health Disparities
- Outcomes Research
Background:
- Coronary heart disease (CHD) is a leading cause of mortality in Black individuals.
- Limited understanding exists regarding long-term outcomes of coronary artery bypass surgery (CABS) in this demographic.
- Preoperative medical characteristics and health insurance impact on CABS outcomes remain unclear.
Purpose of the Study:
- To investigate the effects of medical risk factors on survival outcomes after CABS.
- To compare CABS outcomes between Black and White patients.
- To assess the influence of health insurance on CABS results in a mixed-race cohort.
Main Methods:
- Retrospective analysis of 3728 patients undergoing CABS between 1984 and 1992.
- Inclusion of 115 Black and 3113 White patients.
- Comparison of survival probabilities, operative mortality, and preoperative risk factors.
Main Results:
- Black patients exhibited lower 5-year survival rates (64% vs. 82%, P=.001) post-CABS.
- Higher prevalence of hypertension, diabetes, and current smoking observed in Black patients.
- Operative mortality was similar between racial groups (5.2% vs. 4.1%, P=.48).
- Race remained a significant predictor of long-term survival in Cox regression analysis (adjusted hazard ratio, 2.10).
Conclusions:
- Black patients undergoing CABS faced double the risk of death at 5 years compared to White patients.
- Race is an independent risk factor for long-term survival after CABS.
- Disparities in outcomes highlight the need for further investigation into underlying causes.
Background:
Coronary heart disease is the leading cause of death among blacks, but little is known about the late results of coronary artery bypass surgery in this population. It is not known whether differences in preoperative medical characteristics or medical health insurance affect outcome. We studied the effects of medical risk factors on survival outcome after coronary artery bypass surgery in a population of medically insured black and white patients.
Methods:
Racial status and outcomes from surgery were determined in 3728 consecutive patients who had coronary artery bypass surgery at the authors' institution from January 1, 1984, to June 30, 1992. Coronary artery bypass surgery (excluding valve replacement) was performed in 115 black and 3113 white patients.
Results:
Late survival probability was worse for blacks than whites at 1 year (84% vs 92%) and at 5 years (64% vs 82%, P=.001, Wilcoxon test). Most deaths were due to cardiac events in both groups (68% in blacks vs 67% in whites). Blacks had more hypertension (84% vs 54%), diabetes mellitus (36% vs 23%), and more were current smokers (21% vs 14%) (all P<.05, Fisher's exact test). Medical insurance coverage for blacks and whites was as follows: Medicare (60% vs 57%), private (38% vs 42%), and Medi-Cal (2% vs 2%). Operative mortality (30 days) was similar (5.2% for blacks vs 4.1% for whites; P=.48, Fisher's exact test). In a Cox regression model, race predicted long-term survival and persisted as an important risk factor after adjusting for preoperative factors related to patient survival (adjusted hazard ratio, 2.10; 95% confidence interval, 1.43 to 3.07).
Conclusions:
In this group of predominantly medically insured patients undergoing coronary artery bypass surgery, the risk of death in blacks at 5 years was twice that of whites.