Abstract P234: Racial Disparities in Coronary Revascularization Procedure Mortality: Does the Type of Procedure Matter?

Abstract

BACKGROUND: Racial disparities in treatment procedure mortality contribute to long-term mortality disparities. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI; coronary angioplasty) are two common revascularization procedures for coronary heart disease (CHD) interventional therapy. In-hospital post-coronary revascularization procedure mortality contributes to long-term, overall CHD mortality. While racial disparities in long-term CHD mortality have been reported, existence of racial disparities in post-procedure mortality remains an open question of important implications. HYPOTHESIS: We hypothesized that racial disparities in post-CABG and post-PCI mortality would exist. METHODS: We conducted a study of in-hospital mortality in 427,864 patients [mean+SD age: 66.1+11.8 years; 68.5% (292,955 of 427,864) males] after CABG and PCI during the years 2007,2009. Patient race was classified as white, black, or other (Asian, Pacific Islander, Native American). Because post-procedure length of stay in the hospital is relatively short (days, not months), post-procedure in-hospital death was defined as a binary variable (discharged alive vs. deceased). Multivariable logistic regression models were used to obtain adjusted odds ratios (OR) for in-hospital death after CABG and PCI in relation to race, adjusting for confounding factors - patient and hospital characteristics (age, gender, socio-economic status, Elixhauser comorbidity measures, emergency department admission, rural/urban area status). RESULTS: Significantly higher percentage of black patients were admitted via emergency department (44.8%) as compared to other (37.8%) and white (36.2%) patients (p<0.001). Compared to whites and other patients, blacks had higher prevalence of congestive heart failure, diabetes mellitus, hypertension, obesity, and renal failure (p<0.001 for each condition). Crude post-CABG in-hospital mortality was 2.7% (2,982 of 111,830 patients) and post-PCI - 1.2% (3,890 of 316,034 patients). Adjusted post-CABG in-hospital mortality in blacks was higher than in whites (adjusted OR = 1.172, 95% CI: 1.006-1.364, p=0.042), but in other patients was similar to whites (adjusted OR = 1.048, 95% CI: 0.874-1.257, p=0.610). Adjusted post-PCI in-hospital mortality in blacks was lower (adjusted OR = 0.813, 95% CI: 0.710-0.931, p=0.003) and in other patients was higher (adjusted OR = 1.300, 95% CI: 1.129-1.496, p<0.001) than in whites. CONCLUSIONS: Our findings are indicative of two distinctive patterns of racial disparities in post-coronary revascularization procedure mortality. Blacks have a higher post-CABG mortality and lower post-PCI mortality than whites. Other patients have a higher post-PCI mortality than whites, but similar post-CABG mortality. Further studies of the mechanisms responsible for these racial disparity patterns are needed.