Ethnic differences in invasive management of coronary disease: prospective cohort study of patients undergoing angiography.
OBJECTIVE
To compare rates of revascularisation in south Asian and white patients undergoing coronary angiography in relation to the appropriateness of revascularisation and clinical outcome.


METHODS
Prospective cohort study of patients with two and a half years' follow up; appropriateness of revascularisation rated by nine experts with no knowledge of ethnicity of patient.


METHODS
Tertiary cardiac centre in London with referral from five contiguous health authorities.


METHODS
Consecutive patients (502 south Asian, 2974 white) undergoing coronary angiography in the appropriateness of coronary revascularisation study (ACRE).


METHODS
Coronary revascularisation, non-fatal myocardial infarction, mortality.


RESULTS
There was no difference between south Asian and white patients in the proportions deemed appropriate for revascularisation (72% (361) v 68% (2022)) or in the proportions for whom the physician's intended management was revascularisation (39% (196) v 41% (1218)). Among patients appropriate for revascularisation, age adjusted rates of coronary angioplasty (hazard ratio 0.69, 95% confidence interval 0.47 to 1.00, P=0.058) and coronary artery bypass grafting (0.74, 0.58 to 0.91, P=0.007) were lower in south Asian than in white patients. These differences were smaller but still present after adjustment for socioeconomic status and after restriction of analysis to those patients for whom the intended management was revascularisation. There were no differences in mortality and non-fatal myocardial infarction between south Asian and white patients (1.07, 0.78 to 1.47).


CONCLUSIONS
Among patients deemed appropriate for coronary artery bypass grafting, south Asian patients are less likely than white patients to receive it. This difference is not explained by physician bias.
Feder
Gene
G
Department of General Practice and Primary Care, Barts and the London, Queen Mary's School of Medicine and Dentistry, London EN1 4NS. g.s.feder@qmul.ac.uk
Crook
Angela M
AM
Magee
Patrick
P
Banerjee
Shrilla
S
Timmis
Adam D
AD
Hemingway
Harry
H
D000368:Aged; D001208:Asia / Q000208:ethnology; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D018579:Patient Selection; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012923:Social Class