Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry.
BACKGROUND
Although populations referred for coronary angiography are increasingly diverse, there is limited information on coronary artery disease (CAD) prevalence and in-hospital mortality other than for predominately white male patients.


RESULTS
We examined gender and ethnic differences in CAD prevalence and in-hospital mortality in a prospective cohort of patients referred for angiographic evaluation of stable angina (n=375,886) or acute coronary syndromes (ACS; unstable angina or myocardial infarction, n=450,329) at 388 US hospitals participating in the American College of Cardiology-National Cardiovascular Data Registry, an angiographic registry. Univariable and multivariable (with covariates that included risk factors, symptoms, and comorbidities) logistic regression models were used to estimate significant CAD, defined as > or = 70% stenosis, and in-hospital mortality. Within stable angina and ACS cohorts, 7% of patients were black, 2% were Hispanic, 0.3% were Native American, 1% were Asian, and 90% were white, respectively. In stable angina, the risk-adjusted OR for significant CAD was 0.34 for women compared with men (P<0.0001), with black women having the lowest risk-adjusted odds (P<0.0001) compared with other females. Among ACS patients, the risk-adjusted OR of significant CAD was 0.47 for women compared with men (P<0.0001); similarly, black women had the lowest risk-adjusted odds (P<0.0001) compared with other females. Higher in-hospital mortality was reported for white women presenting with stable angina (P<0.00001). White women had a 1.34-fold (95% CI 1.21 to 1.48) higher risk-adjusted odds ratio for mortality than white men with stable angina (P<0.0001), with higher rates noted for white women who were older or had significant CAD (both P<0.0001). Lower utilization of elective coronary revascularization, aspirin, and glycoprotein IIb/IIIa inhibitors (all P<0.0001) may have contributed to higher in-hospital mortality for white women. In ACS, higher in-hospital mortality was reported for Hispanic (P=0.015) and white (P<0.0001) women; however, neither white (P=0.51) or Hispanic (P=0.13) women had higher in-hospital risk-adjusted mortality.


CONCLUSIONS
The likelihood for significant CAD at coronary angiography and for in-hospital mortality varied significantly by ethnicity and gender. Future clinical practice guidelines should be tailored to gender subsets of the population, in particular for black women, to improve the efficient use of angiographic laboratories and to target at-risk populations of women and men.
Shaw
Leslee J
LJ
Emory Program in Cardiovascular Outcomes Research and Epidemiology, 1256 Briarcliff Rd NE, Suite 1-N, Emory University School of Medicine, Atlanta, GA 30306, USA. lshaw3@emory.edu
Shaw
Richard E
RE
Merz
C Noel Bairey
CN
Brindis
Ralph G
RG
Klein
Lloyd W
LW
Nallamothu
Brahmajee
B
Douglas
Pamela S
PS
Krone
Ronald J
RJ
McKay
Charles R
CR
Block
Peter C
PC
Hewitt
Kathleen
K
Weintraub
William S
WS
Peterson
Eric D
ED
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality; D001213:Asian / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000401:mortality; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
D010975:Platelet Aggregation Inhibitors