RACIAL VARIATION IN THE USE OF CORONARY-REVASCULARIZATION PROCEDURES - ARE THE DIFFERENCES REAL - DO THEY MATTER

Background Studies have reported that blacks undergo fewer coronary-re vascularization procedures than whites, but it is not clear whether th e clinical characteristics of the patients account for these differenc es or whether they indicate underuse of the procedures in blacks or ov eruse in whites. Methods In a study at Duke University of 12,402 patie nts (10.3 percent of whom were black) with coronary disease, we calcul ated unadjusted and adjusted rates of angioplasty and bypass surgery i n blacks and whites after cardiac catheterization. We also examined pa tterns of treatment after stratifying the patients according to the se verity of disease, angina status, and estimated survival benefit due t o revascularization. Finally, we compared five-year survival rates in blacks and whites. Results After adjustment for the severity of diseas e and other characteristics, blacks were 13 percent less likely than w hites to undergo angioplasty and 32 percent less likely to undergo byp ass surgery. The adjusted black:white odds ratios for receiving these procedures were 0.87 (95 percent confidence interval, 0.73 to 1.03) an d 0.68 (95 percent confidence interval, 0.56 to 0.82), respectively. T he racial differences in rates of bypass surgery persisted among those with severe anginal symptoms (31 percent of blacks underwent surgery, vs. 45 percent of whites; P<0.001) and among those predicted to have the greatest survival benefit from revascularization (42 percent vs. 6 1 percent, P<0.001). Finally, unadjusted and adjusted rates of surviva l for five years were significantly lower in blacks than in whites. Co nclusions Blacks with coronary disease were significantly less likely than whites to undergo coronary revascularization, particularly bypass surgery - a difference that could not be explained by the clinical fe atures of their disease. The differences in treatment were most pronou nced among those predicted to benefit the most from revascularization. Since these differences also correlated with a lower survival rate in blacks, we conclude that coronary revascularization appears to be und erused in blacks. (C)1997, Massachusetts Medical Society.