SURVIVAL DETERMINANTS IN BLACK PATIENTS WITH ANGIOGRAPHICALLY DEFINED CORONARY-ARTERY DISEASE

Long-term survlval of blacks with angiographically defined coronary artery disease was examined in a series of 1233 consecutive patients who underwent cardiac catheterzation at a large urban municipal hospital. Vital status information, was available at a mean of 86 weeks for the cohort as a whole, and 94 deaths were recorded. As noted in other angiographic series that included blacks, a high proportion of patients in this study had unobstructed, coronary arteries (41%), and there was a preponderance of women (56%). Hypertension was present in 82% of the cases. whereas 68% of the sample had left ventricular hypertrophy as revealed by echocardiogram. The cumulative proportion of patients who were surviving at 5 years was 90±1 (±SEM), 79±4, and 70±4 for patients with no obstructive lesions, one-vessel disease, and multivessel disease, respectively. The survival rate at 3 years for patients who had undergone bypass surgery (N=152) was only 82% (±5%). Noninvasive univariate predictors of mortality included male sex, history of myocardial infarction, Q waves on electrocardiogram, exercise duration on treadmill stress testing, and left ventricular hypertrophy. Angiographic predictors included left ventricular end-diastolic pressure, the number of diseased coronary vessels, ejection fraction, and mean pulmonary artery pressure. Regression analysis showed an independent association for all the angiographic variables noted previously, as well as for echocardiographically determined left ventricular hypertrophy. Survival rates for blacks with coronary artery disease in this series were considerably lower than those currently reported for whites, particularly for patients who underwent coronary bypass grafting. Over and above the standard angiographic predictors, measures of ventricular hypertrophy and decreased diastolic function that are associated with hypertension appear to be independent correlates of early death and may explain a considerable proportion of the observed excess mortality. © 1990.