Severity of coronary artery disease in black and white male veterans and likelihood of revascularization

Background Many reports in the literature have found the use of invasive ca rdiac procedures in black patients to be less common than in white patients . These reports tend to have small numbers of black patients compared with white patients or rely on the information contained in claims or administra tive data. Methods and Results Cardiac catheterization reports were reviewed in a Vete rans Administration hospital that serves a large number of black patients. After review of the medical histories and hemodynamic and angiographic find ings in 726 black and 734 white male veterans, data were collected to deter mine recommended and actual therapy. Death was assessed after a 4- to 10-ye ar follow-vp period. White patients were more likely to have significant co ronary artery lesions than black patients. Multivariate analysis showed tha t the likelihood of patients actually having percutaneous transluminal coro nary angioplasty or coronary artery bypass surgery did not differ by ethnic ity when controlling for disease extent or severity. Coronary artery bypass surgery was associated with decreased mortality rates for both black and w hite patients. Although short-term death in blacks was not different from w hites, blacks had an increased long-term risk for death. Conclusions After coronary angiography, black veterans and white veterans a ppear to undergo revascularization procedures related to the severity of di sease. The decreased long-term life expectancy of black men as compared wit h whites is not necessarily explained by the presence of or treatment for c oronary artery disease in this population.