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

Rodrigo Zea-Vera, Sainath Asokan, Rohan M. Shah, Christopher T. Ryan, Subhasis Chatterjee, Matthew J. Wall, Joseph S. Coselli, Todd K. Rosengart, Waleed T. Kayani, Hani Jneid, Ravi K. Ghanta

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objective: Studies have noted racial/ethnic disparities in coronary artery disease intervention strategies. We investigated trends and outcomes of coronary artery disease treatment choice (coronary artery bypass grafting or percutaneous coronary intervention) stratified by race/ethnicity. Methods: We queried the National Inpatient Sample for patients who underwent isolated coronary artery bypass grafting or percutaneous coronary intervention (2002-2017). Outcomes were stratified by race/ethnicity (White, African American, Hispanic, Asian). Multivariable logistic regression evaluated associations between race/ethnicity and receiving coronary artery bypass grafting versus percutaneous coronary intervention, in-hospital mortality, and costs. Results: Over the 15-year period, 2,426,917 isolated coronary artery bypass grafting surgeries and 7,184,515 percutaneous coronary interventions were performed. Compared with White patients, African American patients were younger (62 [interquartile range, 53-70] vs 66 [interquartile range, 57-75] years), were more likely to have Medicaid insurance (12.2% vs 4.4%), and had more comorbidities (Charlson-Deyo index, 1.9 ± 1.6 vs 1.7 ± 1.6) (all P < .01). After adjustment for patient comorbidities, presence of acute myocardial infarction, insurance status, and geography, African Americans were the least likely of all racial/ethnic groups to undergo coronary artery bypass grafting (odds ratio, 0.76; P < .01), a consistent trend throughout the study. African American patients had higher risk-adjusted mortality after coronary artery bypass grafting (odds ratio, 1.09; P < .01). Race/ethnicity was not associated with increased mortality after percutaneous coronary intervention. African American patients had higher hospitalization costs for coronary artery bypass grafting (+$5816; P < .01) and percutaneous coronary intervention (+$856; P < .01) after controlling for confounders. Conclusions: In this contemporary national analysis, risk-adjusted frequency of coronary artery bypass grafting versus percutaneous coronary intervention for coronary artery disease differed by race/ethnicity. African American patients had lower odds of undergoing coronary artery bypass grafting and worse outcomes. Reasons for these differences merit further investigation to identify opportunities to reduce potential disparities.

Original languageEnglish (US)
Pages (from-to)1087-1096.e5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume166
Issue number4
DOIs
StatePublished - Oct 2023
Externally publishedYes

Keywords

  • coronary artery bypass
  • ethnicity
  • ischemic heart disease
  • outcomes
  • percutaneous coronary interventions
  • race

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Racial/ethnic differences persist in treatment choice and outcomes in isolated intervention for coronary artery disease'. Together they form a unique fingerprint.

Cite this