The effect of race on coronary bypass operative mortality

被引:90
作者
Bridges, CR
Edwards, FH
Peterson, ED
Coombs, LP
机构
[1] Univ Penn Hlth Syst, Dept Surg, Philadelphia, PA USA
[2] Univ Florida, Hlth Sci Ctr, Dept Surg, Jacksonville, FL 32209 USA
[3] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA
[4] Duke Clin Res Inst, Durham, NC USA
关键词
D O I
10.1016/S0735-1097(00)00956-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The study was done to determine whether race is an independent predictor of operative mortality after coronary artery bypass graft (CABG) surgery. BACKGROUND Blacks are less frequently referred for cardiac catheterization and CABG than are whites. Few reports have investigated the relative fate of patients who undergo CABG as a function of race. METHODS The Society of Thoracic Surgeons National Database was used to retrospectively review 25,850 black and 555,939 white patients who underwent CABG-alone from 1994 through 1997. A multivariate logistic regression model was developed to determine whether race affected risk-adjusted operative mortality. RESULTS Operative mortality was 3.83% far blacks versus 3.14% for whites (unadjusted black/white odds ratio [OR] 1.23 [1.15-1.31]). Blacks were younger, more likely female, hypertensive, diabetic and in heart failure. Nonetheless, the influence of these and other preoperative risk factors on procedural mortality was quite similar in black and white patients. After controlling for all risk factors, race remained a significant independent predictor of mortality in the multivariate logistic model (adjusted black/white OR 1.29 [1.21, 1.38]). proportionately, these differences were greatest among lower-risk patients. The race-by-gender interaction was significant (p < 0.05). The unadjusted mortality for black men, 3.30% and white men, 2.64% differed significantly (p < 0.05), whereas for women there was no difference (black, 4.49%; white 4.41%). CONCLUSIONS Black race is an independent predictor of operative mortality after CABG except for very high-risk patients. The difference in mortality is greatest for male patients and, though statistically significant, is small in absolute terms. Therefore, patients should be referred for CABG based on clinical characteristics irrespective of race. (C) 2000 by the American College of Cardiology.
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收藏
页码:1870 / 1876
页数:7
相关论文
共 30 条
[1]   RACIAL-DIFFERENCES IN THE USE OF REVASCULARIZATION PROCEDURES AFTER CORONARY ANGIOGRAPHY [J].
AYANIAN, JZ ;
UDVARHELYI, IS ;
GATSONIS, CA ;
PASHOS, CL ;
EPSTEIN, AM .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 269 (20) :2642-2646
[2]   RACIAL AND ETHNIC-DIFFERENCES IN THE USE OF INVASIVE CARDIAC PROCEDURES AMONG CARDIAC PATIENTS IN LOS-ANGELES-COUNTY, 1986 THROUGH 1988 [J].
CARLISLE, DM ;
LEAKE, BD ;
SHAPIRO, MF .
AMERICAN JOURNAL OF PUBLIC HEALTH, 1995, 85 (03) :352-356
[3]   Ethnic differences in the identification of left ventricular hypertrophy in the hypertensive patient [J].
Chapman, JN ;
Mayet, J ;
Chang, CL ;
Foale, RA ;
Thom, SAM ;
Poulter, NR .
AMERICAN JOURNAL OF HYPERTENSION, 1999, 12 (05) :437-442
[4]   Impact of gender on coronary bypass operative mortality [J].
Edwards, FH ;
Carey, JS ;
Grover, FL ;
Bero, JW ;
Hartz, RS .
ANNALS OF THORACIC SURGERY, 1998, 66 (01) :125-131
[5]   RACE-DIFFERENCES AND SEX-DIFFERENCES IN RATES OF INVASIVE CARDIAC PROCEDURES IN US-HOSPITALS - DATA FROM THE NATIONAL HOSPITAL DISCHARGE SURVEY [J].
GILES, WH ;
ANDA, RF ;
CASPER, ML ;
ESCOBEDO, LG ;
TAYLOR, HA .
ARCHIVES OF INTERNAL MEDICINE, 1995, 155 (03) :318-324
[6]   Coronary heart disease incidence and survival in African-American women and men - The NHANES I epidemiologic follow-up study [J].
Gillum, RF ;
Mussolino, ME ;
Madans, JH .
ANNALS OF INTERNAL MEDICINE, 1997, 127 (02) :111-+
[7]   Coronary revascularization and cardiac catheterization in the United States: Trends in racial differences [J].
Gillum, RF ;
Gillum, BS ;
Francis, CK .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1997, 29 (07) :1557-1562
[8]   Adverse 5-year outcome after coronary artery bypass surgery in blacks [J].
Gray, RJ ;
Nessim, S ;
Khan, SS ;
Denton, T ;
Matloff, JM .
ARCHIVES OF INTERNAL MEDICINE, 1996, 156 (07) :769-773
[9]   Effect of African-American race and hypertensive left ventricular hypertrophy on coronary vascular reactivity and endothelial function [J].
Houghton, JL ;
Smith, VE ;
Strogatz, DS ;
Henches, NL ;
Breisblatt, WM ;
Carr, AA .
HYPERTENSION, 1997, 29 (03) :706-714
[10]   RACIAL-DIFFERENCES IN MYOCARDIAL-ISCHEMIA AND CORONARY FLOW RESERVE IN HYPERTENSION [J].
HOUGHTON, JL ;
PRISANT, LM ;
CARR, AA ;
FLOWERS, NC ;
FRANK, MJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1994, 23 (05) :1123-1129