Key result
Black race is linked to ~29% higher operative mortality after CABG versus white race.
Why the study?
Blacks are less frequently referred for cardiac catheterization and CABG than whites, and few reports had evaluated operative mortality after CABG as a function of race.
Does black race independently predict operative mortality after CABG compared to white race?
Cohort (n=581,789)
Yes
Does black race independently predict operative mortality after CABG compared to white race?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“As a whole, blacks have higher mortality rates following bypass surgery than whites, but these differences are most pronounced for hypertensive blacks and for black males. There are subtle differences in the biology of hypertension in blacks and whites that need to be explored, including more severe, and frequent, ventricular hypertrophy, an enlargement of the heart's chambers.”
Black race is an independent predictor of operative mortality after CABG, particularly in male and lower-risk patients, though the absolute difference is small.
OBJECTIVES: The study was done to determine whether race is an independent predictor of operative mortality after coronary artery bypass graft (CABG) surgery. BACKGROUND: Blacks are less frequently referred for cardiac catheterization and CABG than are whites. Few reports have investigated the relative fate of patients who undergo CABG as a function of race. METHODS: The Society of Thoracic Surgeons National Database was used to retrospectively review 25,850 black and 555,939 white patients who underwent CABG-alone from 1994 through 1997. A multivariate logistic regression model was developed to determine whether race affected risk-adjusted operative mortality. RESULTS: Operative mortality was 3.83% for blacks versus 3.14% for whites (unadjusted black/white odds ratio [OR] 1.23 [1.15-1.31]). Blacks were younger, more likely female, hypertensive, diabetic and in heart failure. Nonetheless, the influence of these and other preoperative risk factors on procedural mortality was quite similar in black and white patients. After controlling for all risk factors, race remained a significant independent predictor of mortality in the multivariate logistic model (adjusted black/white OR 1.29 [1.21, 1.38]). Proportionately, these differences were greatest among lower-risk patients. The race-by-gender interaction was significant (p<0.05). The unadjusted mortality for black men, 3.30% and white men, 2.64% differed significantly (p<0.05), whereas for women there was no difference (black, 4.49%; white 4.41%). CONCLUSIONS: Black race is an independent predictor of operative mortality after CABG except for very high-risk patients. The difference in mortality is greatest for male patients and, though statistically significant, is small in absolute terms. Therefore, patients should be referred for CABG based on clinical characteristics irrespective of race.
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Bridges et al. (2000) conducted a cohort in Coronary artery disease requiring CABG (n=581,789). Black race vs. White race was evaluated on Operative mortality (OR 1.29, 95% CI 1.21-1.38). Black race was an independent predictor of operative mortality after CABG compared to white race (3.83% vs 3.14%; adjusted OR 1.29, 95% CI 1.21-1.38).
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