Racial differences in the management of unstable angina: Results from the multicenter GUARANTEE registry

Background Prior studies, usually conducted with the use of insurance datab ases, have shown differences in the use of cardiac procedures between black patients and white patients hospitalized with various types of coronary ar tery disease. However, few data are available in prospectively collected co horts of patients with unstable angina or on the use of appropriate medicat ions OF interventions. Methods and Results We evaluated 2948 consecutive patients with unstable an gina admitted to 35 hospitals across the United States in 1996, comparing n onwhite and white patients. Seventy-seven percent of patients were white, 1 4% were black, 4% were Hispanic, 1% were Asian, and 3% were other or unknow n race. Differences were seen in coronary risk profile, with a higher incid ence of hypertension and diabetes mellitus in nonwhites. Cardiac catheteriz ation was performed less often in nonwhites compared with whites (36% vs 53 %, P = .001). Even in patients meeting the criteria for appropriate cathete rization in the Agency for Health Care Policy Research unstable angina guid elines, fewer nonwhites underwent catheterization (44% vs 61%, P = .001), b ut among these, fewer nonwhites had significant coronary stenosis (72% vs 9 0%, P = .001). However, among patients catheterized who had indications for revascularization, angioplasty and coronary artery bypass grafting were pe rformed equally often in nonwhites and whites. Conclusions Current guidelines would recommend more aggressive use of cardi ac catheterization for nonwhite patients. However, our findings suggest tha t racial differences may need to be included in the diagnostic and interven tional algorithms.