Key result
Following isolated CABG, Indigenous Australians had similar 30-day all-cause mortality but higher cardiac mortality compared to non-Indigenous Australians (1.5% vs 0.8%, P=0.02).
Why the study?
Does Indigenous Australian status portend a worse short-term prognosis following isolated coronary artery bypass grafting compared to non-Indigenous status?
Cohort (n=36,902)
Yes
Does Indigenous Australian status portend a worse short-term prognosis following isolated coronary artery bypass grafting compared to non-Indigenous status?
Absolute Event Rate: 1.5% vs 0.8%
p-value: p=0.02
Despite higher baseline comorbidities and procedural differences, Indigenous Australians have similar short-term all-cause mortality following isolated CABG compared to non-Indigenous Australians, though they experience higher rates of bleeding and cardiac mortality.
Indigenous Australians show similar short-term CABG mortality despite comorbidities; leaves open long-term survival and conduit optimization questions.
BACKGROUND: Indigenous Australians have higher rates of cardiovascular disease and comorbidities compared to their non-indigenous counterparts. AIMS: We sought to evaluate whether indigenous status per se portends a worse prognosis following isolated coronary artery bypass grafting (CABG). METHODS: The outcomes of 778 Indigenous Australians (55 ± 10 years; 32% female) enrolled in the Australian and New Zealand Society of Cardiac and Thoracic Surgeons registry were compared to 36 124 non-Indigenous Australians (66 ± 10 years; 21% female) following isolated CABG. In a secondary analysis, patients were propensity-matched by age, sex, renal function, diabetes and ejection fraction (778 individuals in each group). RESULTS: Indigenous Australians were younger and more likely to be female and current smokers and to have diabetes, hypertension, renal impairment, heart failure and previous CABG (all P < 0.04). Indigenous patients had fewer bypasses with arterial conduits (including less internal mammary artery use) and a higher number of distal vein anastomoses (P < 0.001). Postoperative bleeding rates were higher in indigenous patients (P = 0.001). However, in-hospital and 30-day all-cause mortality and rates of 30-day readmission were similar between both groups, although cardiac mortality was higher in the indigenous cohort (1.5% vs 0.8%, P = 0.02). With propensity-matching, rates of postoperative complications were similar among the two groups, with the exception of bleeding, which remained higher in Indigenous Australians (P = 0.03). CONCLUSIONS: Despite procedural differences and higher rates of baseline comorbidities, Indigenous Australians do not have worse short-term outcomes following isolated CABG. Given the higher rates of baseline comorbidities and lower rates of arterial conduit use, it will be essential to determine long-term outcomes.
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O’Brien et al. (2018) conducted a cohort in Coronary artery disease requiring isolated coronary artery bypass grafting (n=36,902). Indigenous Australian status vs. Non-Indigenous Australians was evaluated on Cardiac mortality (p=0.02). Following isolated CABG, Indigenous Australians had similar 30-day all-cause mortality but higher cardiac mortality compared to non-Indigenous Australians (1.5% vs 0.8%, P=0.02).
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