Operative Status and Survival after Coronary Artery Bypass Grafting (original) (raw)
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The effect of race on coronary bypass operative mortality
Journal of the American College of Cardiology, 2000
OBJECTIVES The study was done to determine whether race is an independent predictor of operative mortality after coronary artery bypass graft (CABG) surgery. BACKGROUND Blacks are less frequently referred for cardiac catheterization and CABG than are whites. Few reports have investigated the relative fate of patients who undergo CABG as a function of race. METHODS The Society of Thoracic Surgeons National Database was used to retrospectively review 25,850 black and 555,939 white patients who underwent CABG-alone from 1994 through 1997. A multivariate logistic regression model was developed to determine whether race affected risk-adjusted operative mortality. RESULTS Operative mortality was 3.83% for blacks versus 3.14% for whites (unadjusted black/white odds ratio [OR] 1.23 [1.15-1.31]). Blacks were younger, more likely female, hypertensive, diabetic and in heart failure. Nonetheless, the influence of these and other preoperative risk factors on procedural mortality was quite similar in black and white patients. After controlling for all risk factors, race remained a significant independent predictor of mortality in the multivariate logistic model (adjusted black/white OR 1.29 [1.21, 1.38]). Proportionately, these differences were greatest among lower-risk patients. The race-by-gender interaction was significant (p Ͻ 0.05). The unadjusted mortality for black men, 3.30% and white men, 2.64% differed significantly (p Ͻ 0.05), whereas for women there was no difference (black, 4.49%; white 4.41%). CONCLUSIONS Black race is an independent predictor of operative mortality after CABG except for very high-risk patients. The difference in mortality is greatest for male patients and, though statistically significant, is small in absolute terms. Therefore, patients should be referred for CABG based on clinical characteristics irrespective of race.
Racial Disparities in Outcomes Following Coronary Artery Bypass Grafting
The Journal of Cardiovascular Nursing, 2006
More than 12 million people in the United States have coronary heart disease, the second leading cause of hospitalization in the United States. It is known that persons within racial minorities, specifically African Americans, have a higher prevalence of coronary heart disease, yet are much less likely to undergo invasive cardiac treatment interventions. An invasive intervention commonly used to treat coronary heart disease is coronary artery bypass grafting, with over 140,000 operations performed annually in the United States. However, blacks are known to experience higher post-coronary artery bypass graft morbidity and mortality. The causes for racial disparities in post-coronary artery bypass graft outcomes are not well known but may include factors related to the individual, provider, system, and society/environment, either alone or in combination. The purpose of this article is to provide an overview of the literature regarding disparities in the health and healthcare of black patients with coronary heart disease with respect to CABG, and examine potential hypotheses for variant outcomes after surgery.
European Journal of Cardio-Thoracic Surgery, 2014
OBJECTIVE: Black patients are less likely to develop postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) than whites. However, the influence of race and POAF on operative mortality has not been examined. The objective of this study was to determine the influence of race and POAF on operative mortality after CABG. METHODS: Patients undergoing elective CABG between 1992 and 2011 were included. Operative mortality was compared between patients with and those without new-onset POAF by race. Relative risk (RR) and 95% confidence intervals (CI) were computed using Poisson (robust variance estimates) and log-binomial regression models. RESULTS: A total of 1215 (23%) patients developed POAF (white n = 1060; black n = 155) following CABG (N = 5387). Operative mortality differed by POAF status within race category (white POAF: adjusted RR = 1.4, 95% CI = 0.86-2.2; black POAF: adjusted RR = 5.0, 95% CI = 1.9-13; P interaction = 0.0016). Black POAF patients had a 2-fold increased risk of operative death compared with white POAF patients (P adjusted = 0.052). CONCLUSION: POAF was observed to be a stronger predictor of operative mortality in black compared with white patients undergoing elective CABG.
Increased Coronary Artery Disease Severity in Black Women Undergoing Coronary Bypass Surgery
Medicine, 2015
Race and sex disparities are believed to play an important role in heart disease. The purpose of this study was to examine the association between race, sex, and number of diseased vessels at the time of coronary artery bypass grafting (CABG), and subsequent postoperative outcomes. The 13,774 patients undergoing first-time, isolated CABG between 1992 and 2011 were included. Trend in the number of diseased vessels between black and white patients, stratified by sex, were analyzed using a Cochran-Armitage trend test. Models were adjusted for age, procedural status (elective vs. nonelective), and payor type (private vs. nonprivate insurance). Black female CABG patients presented with an increasingly greater number of diseased vessels than white female CABG patients (adjusted P trend ¼ 0.0021). A similar trend was not observed between black and white male CABG patients (adjusted P trend ¼ 0.18). Black female CABG patients were also more likely to have longer intensive care unit and hospital lengths of stay than other race-sex groups. Our findings suggest that black female CABG patients have more advanced coronary artery disease than white female CABG patients. Further research is needed to determine the benefit of targeted preventive care and preoperative workup for this high-risk group.
Journal of Cardiac Surgery, 2013
Background and Aim: Postoperative atrial fibrillation (POAF) is a known predictor of in-hospital morbidity and short-term survival after coronary artery bypass grafting (CABG). The impact of race and longterm survival has not been examined in this population. We aimed to examine the influence of these factors on long-term survival in patients undergoing CABG. Methods: Patients undergoing first-time, isolated CABG between 1992 and 2011 were included in this study. Long-term survival was compared in patients with and without POAF and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. Results: A total of 2,907 (22%) patients developed POAF (black n = 370; white n = 2,537) following CABG (N = 13,165). Median follow-up for study participants was 8.2 years. Long-term survival after CABG differed by POAF status and race (no POAF: HR = 1.0; white POAF: adjusted HR = 1.1, 95% CI = 1.06-1.2; black POAF: adjusted HR = 1.4, 95% CI = 1.2-1.6; p Trend = 0.0002). Black POAF patients also died sooner after surgery than their white counterparts (adjusted HR = 1.2, 95% CI = 1.02-1.4). Conclusion: Black race was a statistically significant predictor of decreased survival among POAF patients after CABG. This finding provides useful outcome information for surgeons and their patients.
Frontiers in Public Health, 2013
Background: Chronic obstructive pulmonary disease (COPD) is a known predictor of decreased long-term survival after coronary artery bypass grafting (CABG). Differences in survival by race have not been examined. Methods: A retrospective cohort study was conducted of CABG patients between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. Results: A total of 984 (20%) patients had COPD (black n = 182; white n = 802) at the time of CABG (N = 4,801).The median follow-up for study participants was 4.4 years. COPD was observed to be a statistically significant predictor of decreased survival independent of race following CABG (no COPD: HR = 1.0; white COPD: adjusted HR = 1.9, 95% CI = 1.7-2.3; black COPD: adjusted HR = 1.6, 95% CI = 1.1-2.2). Conclusion: Contrary to the expected increased risk of mortality among black COPD patients in the general population, a similar survival disadvantage was not observed in our CABG population.
Race and Survival among Diabetic Patients after Coronary Artery Bypass Grafting
The Thoracic and Cardiovascular Surgeon, 2013
Diabetes is an important predictor of decreased long-term survival after coronary artery bypass grafting (CABG). 6-11 In addition, the influence of insulin dependency at the time of surgery has been shown to negatively influence survival compared with patients managed by diet or oral hypoglycemic agents. 7-9 Limited information is available regarding how race may affect survival of diabetic patients undergoing CABG. The current study was designed to determine and compare