This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (33)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Richard J. Gray, MD; Sharon Nessim, DrPH; Steven S. Khan, MD; Timothy Denton, MD; Jack M. Matloff, MD

Arch Intern Med. 1996;156(7):769-773.

Abstract
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.

(Arch Intern Med. 1996;156:769-773)

Author Affiliations
From the Department of Cardiothoracic Surgery and Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif. Dr Gray is now affiliated with Health Partners and St Paul Ramsey Medical Center, St Paul, Minn.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Racial Disparity Persists After On-Pump and Off-Pump Coronary Artery Bypass Grafting
Cooper et al.
Circulation 2009;120:S59-S64.
ABSTRACT | FULL TEXT  

Mitral Valve Disease Presentation and Surgical Outcome in African-American Patients Compared With White Patients
DiGiorgi et al.
Ann. Thorac. Surg. 2008;85:89-93.
ABSTRACT | FULL TEXT  

Racial Disparities in Cardiovascular Procedure Outcomes: Turn Down the Volume
Rumsfeld and Epstein
J Am Coll Cardiol 2006;47:425-426.
FULL TEXT  

Operative and Late Coronary Artery Bypass Grafting Outcomes in Matched African-American Versus Caucasian Patients: Evidence of a Late Survival-Medicaid Association
Zacharias et al.
J Am Coll Cardiol 2005;46:1526-1535.
ABSTRACT | FULL TEXT  

Patient and Hospital Differences Underlying Racial Variation in Outcomes After Coronary Artery Bypass Graft Surgery
Konety et al.
Circulation 2005;111:1210-1216.
ABSTRACT | FULL TEXT  

Influence of Racial Disparities in Procedure Use on Functional Status Outcomes Among Patients With Coronary Artery Disease
Kaul et al.
Circulation 2005;111:1284-1290.
ABSTRACT | FULL TEXT  

In Search of Fewer Independent Risk Factors
Brotman et al.
Arch Intern Med 2005;165:138-145.
ABSTRACT | FULL TEXT  

Explaining disparities in access to high-quality cardiac surgeons
Rothenberg et al.
Ann. Thorac. Surg. 2004;78:18-24.
ABSTRACT | FULL TEXT  

Cardiac surgery in African Americans
Bridges
Ann. Thorac. Surg. 2003;76:S1356-1362.
ABSTRACT | FULL TEXT  

The impact of ethnicity on outcomes following coronary artery bypass graft surgery in the Veterans Health Administration
Rumsfeld et al.
J Am Coll Cardiol 2002;40:1786-1793.
ABSTRACT | FULL TEXT  

Racial Differences in Mortality Among Men Hospitalized in the Veterans Affairs Health Care System
Jha et al.
JAMA 2001;285:297-303.
ABSTRACT | FULL TEXT  

The effect of race on coronary bypass operative mortality
Bridges et al.
J Am Coll Cardiol 2000;36:1870-1876.
ABSTRACT | FULL TEXT  

Racial Differences in CABG Outcomes
Journal Watch Cardiology 1996;1996:8-8.
FULL TEXT