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CLINICAL STUDY: CHRONIC CORONARY ARTERY DISEASE

The impact of ethnicity on outcomes following coronary artery bypass graft surgery in the Veterans Health Administration

John S. Rumsfeld, MD, PhD, FACC^*,*, Mary E. Plomondon, MSPH^*, Eric D. Peterson, MD, MPH, FACC, Michael G. Shlipak, MD, MPH, Charles Maynard, PhD, Gary K. Grunwald, PhD^*, Frederick L. Grover, MD^* and A. Laurie W. Shroyer, PhD^*

^* Denver VA Medical Center, Denver, Colorado, USA
Duke University Medical Center, Durham, North Carolina, USA
San Francisco VA Medical Center, San Francisco, California, USA
VA Puget Sound Health Care System, Seattle, Washington, USA

Manuscript received April 3, 2002; revised manuscript received July 23, 2002, accepted August 1, 2002.

^* Reprint requests and correspondence: Dr. John S. Rumsfeld, Cardiology (111B), Denver VA Medical Center, 1055 Clermont Street, Denver, Colorado 80220, USA.
john.rumsfeld{at}med.va.gov

OBJECTIVES: We evaluated the effect of African American (AA) and Hispanic American (HA) ethnicity on mortality and complications following coronary artery bypass graft (CABG) surgery in the Veterans Health Administration (VHA).

BACKGROUND: Few studies have examined the impact of ethnicity on outcomes following cardiovascular procedures.

METHODS: This study included all 29,333 Caucasian, 2,570 AA, and 1,525 HA patients who underwent CABG surgery at any one of the 43 VHA cardiac surgery centers from January 1995 through March 2001. We evaluated the relationship between ethnicity (AA vs. Caucasian and HA vs. Caucasian) and 30-day mortality, 6-month mortality, and 30-day complications, adjusting for a wide array of demographic, cardiac, and noncardiac variables.

RESULTS: After adjustment for baseline characteristics, AA and Caucasian patients had similar 30-day (AA/Caucasian odds ratio [OR] 1.07; 95% confidence interval [CI] 0.84 to 1.35; p = 0.59) and 6-month mortality risk (AA/Caucasian OR 1.10; 95% CI 0.91 to 1.34; p = 0.31). However, among patients with low surgical risk, AA ethnicity was associated with higher mortality (OR 1.52, CI 1.10 to 2.11, p = 0.01), and AA patients were more likely to experience complications following surgery (OR 1.28; 95% CI 1.14 to 1.45; p < 0.01). In contrast, HA patients had lower 30-day (HA/Caucasian OR 0.70; 95% CI 0.49 to 0.98; p = 0.04) and 6-month mortality risk (HA/Caucasian OR 0.66; 95% CI 0.50 to 0.88; p < 0.01) than Caucasian patients.

CONCLUSIONS: Ethnicity does not appear to be a strong risk factor for adverse outcomes following CABG surgery in the VHA. Future studies are needed to determine why AA patients have more complications, but ethnicity should not affect the decision to offer the operation.

Abbreviations and Acronyms   AA   African American   CABG   coronary artery bypass graft   CI   confidence interval   CICSP   Continuous Improvement in Cardiac Surgery Program   HA   Hispanic American   LVH   left ventricular hypertrophy   OR   odds ratio   PCI   percutaneous coronary intervention   VA   Veterans Affairs   VHA   Veterans Health Administration

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