Clinical and nonclinical correlates of racial and ethnic differences in recommendation patterns for coronary revascularization.
BACKGROUND
We sought to determine whether gender or racial differences exist in recommendations for coronary revascularization in a multiracial patient population undergoing their first coronary angiography at an academic institution from 1990-1993 for the evaluation of coronary artery disease (CAD).


OBJECTIVE
For patients with clinically significant CAD, no racial differences exist in the recommendation to revascularization following coronary angiography.


METHODS
The main outcome measure was a recommendation for coronary revascularization such as percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) for patients with clinically significant CAD (n = 590). The primary multiple logistic regression analysis focused on only those patients with angiographically severe disease, defined as triple-vessel or left main CAD (n = 180). Race was trichotomized into Hispanic, black, and white to ascertain whether any differential effects of race/ethnicity existed while controlling for age, gender, ejection fraction, angina, diabetes, hypertension, and peripheral vascular disease. A medical record review for all patients with severe CAD, who were given a recommendation for medical therapy, was conducted to ascertain whether previously unmeasured clinical factors or nonclinical factors may have precluded a PTCA/CABG recommendation.


RESULTS
Hispanics with severe disease were significantly less likely than whites to be given a recommendation for PTCA/CABG following angiography [odds ratio (OR) = 0.39; 95% confidence interval (CI) (0.17, 0.92)]. Blacks were 67% as likely as whites to be given such a recommendation [OR = 0.67; 95% CI (0.17, 2.71)]. Medical records, reviewed for 35 of 40 of these patients given a recommendation for medical therapy, revealed that 6 patients eventually had PTCA/CABG within 6 months due to precipitating ischemic events; 9 had such severe or diffuse disease that revascularization did not appear to be an alternative, and 2 patients opted for medical therapy.


CONCLUSIONS
Racial differences were manifested in the recommendations made following angiography and may be explained by previously unmeasured clinical as well as nonclinical factors.
Barnhart
J M
JM
Department of Epidemiology, Albert Einstein College of Medicine, Bronx, New York, USA.
Wassertheil-Smoller
S
S
Monrad
E S
ES
D003327:Coronary Disease / Q000601:surgery*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization; D044469:Racial Groups; D012737:Sex Factors