The Impact of Race on Outcomes of Revascularization for Multivessel Coronary Artery Disease

Ann Thorac Surg. 2020 Oct 7:S0003-4975(20)31626-X. doi: 10.1016/j.athoracsur.2020.08.005. Online ahead of print.

ABSTRACT

BACKGROUND: Racial disparities exist between black and white patients with coronary artery disease with regards to access to revascularization, pre-procedural co-morbidities, and post-procedural outcomes. This study investigated the differences in the treatment of multivessel coronary artery disease (MVCAD) and long-term outcomes between black and white patients.

METHODS: This was a propensity-matched retrospective analysis that utilized pooled institutional data from a large, multi-hospital healthcare system. It included black and white patients who underwent coronary revascularization for MVCAD between 2011 to 2018.

RESULTS: A total of 6,005 patients were included, 5,689 white and 316 black. In the unmatched cohort, black patients had a higher incidence of pre-existing comorbidities such as diabetes, dialysis-dependence, peripheral arterial disease, heart failure, and underwent PCI more frequently. Five-year overall survival was similar, but black patients experienced higher rates of MACCE and repeat revascularization. Propensity matching resulted in a sample of 926 (312 black, 614 white) patients that were well-matched. In the matched analysis, black patients underwent PCI more frequently and had higher rate of stoke. Five-year survival, MACCE and repeat revascularization rates were comparable.

CONCLUSIONS: Black patients with MVCAD have a higher comorbidity burden and undergo PCI at higher rates. After adjusting for baseline differences, black patients still had higher rates of PCI utilization and long-term stroke. It is possible that a significant portion of racial disparities in MVCAD are driven by differences in baseline risk, however, there is evidence of possible racial bias with regards to revascularization strategies.

PMID:33038339 | DOI:10.1016/j.athoracsur.2020.08.005