RACIAL VARIATION IN CARDIAC PROCEDURE USE AND SURVIVAL FOLLOWING ACUTE MYOCARDIAL-INFARCTION IN THE DEPARTMENT-OF-VETERANS-AFFAIRS

Objective.-To examine whether blacks admitted to Veterans Affairs Medi cal Centers (VAMCs) with an acute myocardial infarction (AMI) are less likely than whites to undergo cardiac catheterization or coronary rev ascularization procedures and to determine the impact of these differe nces on patient survival. Design.-A retrospective observational study of inpatient discharge abstracts from the Veterans Health Administrati on (VHA). Setting.-All one hundred fifty-eight acute care hospitals in the VHA. Patient Population.-Male veterans (n=33 641) discharged from VAMCs with an International Classification of Diseases, Ninth Revisio n, Clinical Modification code for AMI from January 1, 1988, to Decembe r 31, 1990. Intervention.- None. Main Outcome Measures.-The use of car diac catheterization, coronary angioplasty, and/or bypass surgery in t he 90 days after admission for AMI, and survival at 30 days, 1 year, a nd 2 years. Main Results.- Adjusting for patient and hospital characte ristics, blacks with an AMI were 33% less likely than whites to underg o cardiac catheterization, 42% less likely to receive coronary angiopl asty, and 54% less likely to receive coronary bypass surgery. Among pa tients who underwent catheterization, blacks were also less likely tha n whites to have a subsequent cardiac revascularization procedure. Adj usted 30-day survival for blacks was significantly greater than for wh ites. One- and 2-year survival rates after AMI were not significantly different between blacks and whites. Conclusions.-In a health care sys tem designed to provide equivalent availability of care to all eligibl e patients, blacks received substantially fewer cardiac procedures aft er AMI than whites. Despite undergoing fewer interventional procedures , blacks had better short-term and equivalent intermediate survival ra tes compared with whites.