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Operative and late coronary artery bypass grafting outcomes in matched African-American versus Caucasian patients: evidence of a late survival-Medicaid association.
J Am Coll Cardiol. 2005 Oct 18; 46(8):1526-35.JACC

Abstract

OBJECTIVES

This study sought to determine whether African-American versus Caucasian race is a determinant of early or late coronary artery bypass surgery (CABG) outcomes.

BACKGROUND

African Americans are referred to CABG less frequently than Caucasians and Medicaid coverage is disproportionately common among those who are referred. How these factors affect the relative early and late CABG outcomes in these groups is incompletely elucidated.

METHODS

A retrospective cohort comparison of operative and 12-year outcomes for 304 African-American and 6,073 Caucasian consecutive patients who underwent isolated CABG (1991 to 2003) at an urban community hospital was used. Results were further confirmed in propensity-matched subgroups (n = 301 each).

RESULTS

African Americans were younger (62 vs. 64 years, median), more were female (46% vs. 30%), more were on Medicaid (29% vs. 6.3%) and had more comorbidities. These differences were eliminated after matching. A total of 161 operative and 1,080 late deaths have been documented. Operative mortality was similar (African American versus Caucasian: 3.0% vs. 2.5%; p = 0.81). Unadjusted Kaplan-Meier survival at 1, 5, and 10 years (93.4%, 80.3%, and 66.1% vs. 94.8%, 86.5%, and 71.7%) was worse in African Americans (hazard ratio [HR] = 1.38; p = 0.004), but similar for matched groups (HR = 1.03; p = 0.97). After risk adjustment, race did not predict operative (odds ratio = 1.17; p = 0.69) or late (HR = 1.15; p = 0.28) mortality. However, Medicaid status (HR = 1.54; p < 0.005) predicted worse survival, which was verified in a case-matched Medicaid (n = 469) versus non-Medicaid analysis. The latter showed that in younger Medicaid patients without companion Medicare coverage, late mortality was nearly doubled (HR = 1.96; p = 0.003) with systematically increasing death hazard after the second year.

CONCLUSIONS

African-American race per se is not associated with worse operative or late outcomes underscoring that CABG should be based on clinical characteristics only. Alternatively, Medicaid status, which is more prevalent among African Americans, is associated with worse late survival, especially in non-Medicare patients. Studies are needed to elucidate this late Medicaid-CABG outcome association.

Authors+Show Affiliations

Division of Cardiovascular Surgery, St. Vincent Mercy Medical Center; Department of Surgery, College of Medicine, The Medical University of Ohio, Toledo, Ohio 43608, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16226179

Citation

Zacharias, Anoar, et al. "Operative and Late Coronary Artery Bypass Grafting Outcomes in Matched African-American Versus Caucasian Patients: Evidence of a Late survival-Medicaid Association." Journal of the American College of Cardiology, vol. 46, no. 8, 2005, pp. 1526-35.
Zacharias A, Schwann TA, Riordan CJ, et al. Operative and late coronary artery bypass grafting outcomes in matched African-American versus Caucasian patients: evidence of a late survival-Medicaid association. J Am Coll Cardiol. 2005;46(8):1526-35.
Zacharias, A., Schwann, T. A., Riordan, C. J., Durham, S. J., Shah, A., & Habib, R. H. (2005). Operative and late coronary artery bypass grafting outcomes in matched African-American versus Caucasian patients: evidence of a late survival-Medicaid association. Journal of the American College of Cardiology, 46(8), 1526-35.
Zacharias A, et al. Operative and Late Coronary Artery Bypass Grafting Outcomes in Matched African-American Versus Caucasian Patients: Evidence of a Late survival-Medicaid Association. J Am Coll Cardiol. 2005 Oct 18;46(8):1526-35. PubMed PMID: 16226179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Operative and late coronary artery bypass grafting outcomes in matched African-American versus Caucasian patients: evidence of a late survival-Medicaid association. AU - Zacharias,Anoar, AU - Schwann,Thomas A, AU - Riordan,Christopher J, AU - Durham,Samuel J, AU - Shah,Aamir, AU - Habib,Robert H, Y1 - 2005/09/29/ PY - 2005/04/05/received PY - 2005/06/21/revised PY - 2005/06/27/accepted PY - 2005/10/18/pubmed PY - 2006/1/20/medline PY - 2005/10/18/entrez SP - 1526 EP - 35 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 46 IS - 8 N2 - OBJECTIVES: This study sought to determine whether African-American versus Caucasian race is a determinant of early or late coronary artery bypass surgery (CABG) outcomes. BACKGROUND: African Americans are referred to CABG less frequently than Caucasians and Medicaid coverage is disproportionately common among those who are referred. How these factors affect the relative early and late CABG outcomes in these groups is incompletely elucidated. METHODS: A retrospective cohort comparison of operative and 12-year outcomes for 304 African-American and 6,073 Caucasian consecutive patients who underwent isolated CABG (1991 to 2003) at an urban community hospital was used. Results were further confirmed in propensity-matched subgroups (n = 301 each). RESULTS: African Americans were younger (62 vs. 64 years, median), more were female (46% vs. 30%), more were on Medicaid (29% vs. 6.3%) and had more comorbidities. These differences were eliminated after matching. A total of 161 operative and 1,080 late deaths have been documented. Operative mortality was similar (African American versus Caucasian: 3.0% vs. 2.5%; p = 0.81). Unadjusted Kaplan-Meier survival at 1, 5, and 10 years (93.4%, 80.3%, and 66.1% vs. 94.8%, 86.5%, and 71.7%) was worse in African Americans (hazard ratio [HR] = 1.38; p = 0.004), but similar for matched groups (HR = 1.03; p = 0.97). After risk adjustment, race did not predict operative (odds ratio = 1.17; p = 0.69) or late (HR = 1.15; p = 0.28) mortality. However, Medicaid status (HR = 1.54; p < 0.005) predicted worse survival, which was verified in a case-matched Medicaid (n = 469) versus non-Medicaid analysis. The latter showed that in younger Medicaid patients without companion Medicare coverage, late mortality was nearly doubled (HR = 1.96; p = 0.003) with systematically increasing death hazard after the second year. CONCLUSIONS: African-American race per se is not associated with worse operative or late outcomes underscoring that CABG should be based on clinical characteristics only. Alternatively, Medicaid status, which is more prevalent among African Americans, is associated with worse late survival, especially in non-Medicare patients. Studies are needed to elucidate this late Medicaid-CABG outcome association. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/16226179/Operative_and_late_coronary_artery_bypass_grafting_outcomes_in_matched_African_American_versus_Caucasian_patients:_evidence_of_a_late_survival_Medicaid_association_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)01771-7 DB - PRIME DP - Unbound Medicine ER -