Effect of race on the clinical outcomes in the bypass angioplasty revascularization investigation trial.
BACKGROUND
In observational studies, clinical outcomes for black patients with coronary disease have been worse than for white patients. There are few data from randomized trials comparing the outcomes of coronary revascularization between black patients and white patients.


RESULTS
We analyzed data from the Bypass Angioplasty Revascularization Investigation randomized trial. At study entry, the 113 black patients had significantly higher rates of diabetes, hypertension, smoking, heart failure, and abnormal left ventricular function than the 1653 white patients. Black patients had significantly higher mortality than white patients (hazard ratio, 2.16; P<0.001), which remained significant after statistical adjustment for differences in baseline clinical characteristics (hazard ratio, 1.59; P=0.003). In a substudy of economic and quality of life outcomes, the 67 black patients had similar frequency of physician visits and use of evidence-based cardiac medications but significantly worse physical function scores than the 885 white patients. The effect of random assignment to either surgery or angioplasty on clinical outcomes was not significantly modified by race (interaction probability values >or=0.18).


CONCLUSIONS
Clinical outcomes of black patients after coronary revascularization were worse than those of white patients in a clinical trial setting with similar treatment and access to care. The differences in outcome between black and white patients were not completely attributable to the greater levels of comorbidity among black patients at study entry.
Melsop
Kathryn
K
Stanford University School of Medicine, Stanford, Calif, USA.
Brooks
Maria M
MM
Boothroyd
Derek B
DB
Hlatky
Mark A
MA
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000706:statistics & numerical data*; D001213:Asian / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D003920:Diabetes Mellitus / Q000208:ethnology / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000208:ethnology / Q000401:mortality; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D044469:Racial Groups / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012907:Smoking / Q000208:ethnology / Q000401:mortality; D018487:Ventricular Dysfunction, Left / Q000208:ethnology / Q000401:mortality; D044465:White People / Q000706:statistics & numerical data