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Long-term survival of African Americans in the Coronary Artery Surgery Study (CASS)
H A Taylor1, M C Mickel, B R Chaitman
1Department of Medicine, University of Alabama at Birmingham, USA.
Insights
Long-term outcomes reveal African Americans with coronary artery disease (CAD) have higher mortality than whites. However, survival for nonsmoking African Americans equals that of nonsmoking whites, regardless of initial treatment.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Coronary artery disease (CAD) mortality is disproportionately higher in African Americans compared to white populations.
- Previous short-term analyses of the Coronary Artery Surgery Study (CASS) suggested similar survival rates for surgically treated African American and white patients.
- This study investigates long-term survival differences in a well-characterized cohort with known or suspected CAD.
Purpose of the Study:
- To determine the long-term (>15 years) prognosis for African Americans with known or suspected coronary artery disease (CAD).
- To assess if African American race is an independent predictor of mortality in patients with CAD.
- To evaluate if initial treatment modality impacts mortality risk among African American patients.
Main Methods:
- Analysis of survival data from the Coronary Artery Surgery Study (CASS) registry.
- Utilized multivariate Cox proportional hazards models to identify independent predictors of mortality.
- Compared 16-year survival rates between African American and white patients, stratified by treatment and smoking status.
Main Results:
- African American patients had significantly lower 16-year survival rates (52%) compared to white patients (60%) (p < 0.00001).
- African American race was an independent predictor of increased mortality in both medical (HR 1.34) and surgical (HR 1.63) treatment groups.
- Smoking status significantly impacted survival; nonsmoking African Americans (60% survival) had survival rates comparable to nonsmoking white patients (61%).
Conclusions:
- Over the long term, African Americans with CAD exhibit higher mortality than whites, irrespective of initial therapy.
- Smoking cessation emerges as a critical factor for improving long-term survival in African Americans with CAD.
- These findings highlight the need for targeted interventions to address CAD disparities in the African American population.
Objectives:
This study sought to determine the long-term (> 15 years) outcome of a clinically well characterized cohort of African Americans with known or suspected coronary artery disease (CAD).
Background:
The mortality rate from CAD is higher in African Americans than in whites. An earlier analysis of data from the Coronary Artery Surgery Study (CASS) registry suggested that African American and white patients treated surgically had equal 5-year survival rates.
Methods:
Survival data from the CASS registry were analyzed to determine whether 1) African American race is an independent predictor of mortality; and 2) initial therapy is predictive of mortality among African American patients.
Results:
Overall, 60% of white and 52% of African American patients survived 16 years (p < 0.00001). Multivariate Cox models confirmed that African American race was independently associated with higher mortality in both the medical group (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.11 to 1.63) and the surgical group (HR 1.63, 95% CI 1.19 to 2.23). Initial therapy was not predictive of survival among African American patients (p = 0.81). However, smoking status significantly influenced survival: African Americans who did not smoke experienced significantly improved survival (60% vs. 48% for smokers), which equaled survival for white nonsmokers (61%, p = NS).
Conclusions:
In contrast to results from shorter term studies, African Americans experienced higher overall mortality rates than whites over the long term, regardless of the type of initial treatment. Survival among nonsmoking African Americans at 16 years equaled survival among nonsmoking whites.