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CLINICAL RESEARCH: CARDIAC IMAGING

Racial Differences in Prevalence of Coronary Obstructions Among Men With Positive Nuclear Imaging Studies

Jeff Whittle, MD, MPH^_*,,_*, Nancy R. Kressin, PhD^,,1, Eric D. Peterson, MD, MPH^||,2, Michelle B. Orner, MPH, Mark Glickman, PhD^,, Marco Mazzella, MD^¶ and Laura A. Petersen, MD, MPH^#,_**

^_* Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, Massachusetts
Health Services Department, Boston University School of Public Health, Boston, Massachusetts
^|| Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
^¶ Division of Cardiology, Kansas University Medical Center, Kansas City, Kansas
^# Division of Health Policy and Quality, Houston Center for Quality of Care and Utilization Studies, Houston VA Medical Center, Houston, Texas
^_** Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.

Manuscript received August 18, 2005; revised manuscript received November 16, 2005, accepted December 13, 2005.

^_* Reprint requests and correspondence: Dr. Jeff Whittle, Clement J. Zablocki VA Medical Center, Mailstop 00 (PC), 5000 West National Avenue, Milwaukee, Wisconsin 53295. (Email: jeffrey.whittle{at}va.gov).

OBJECTIVES: The purpose of this research was to compare coronary obstruction between clinically similar African Americans (AA) and white persons undergoing coronary angiography.

BACKGROUND: African Americans have higher rates of coronary death than whites, but are less likely to undergo coronary revascularization. Although differences in coronary anatomy do not explain racial difference in revascularization rates, several studies of clinically diverse persons undergoing coronary angiography have found less obstructive coronary disease in AA than clinically similar whites.

METHODS: We studied 52 AA and 259 white male veterans who had both a positive nuclear perfusion imaging study and coronary angiography within 90 days of that study in five Department of Veterans Affairs hospitals. We used chart review and patient interview to collect demographics, clinical characteristics, and coronary anatomy results. Before angiography, we asked physicians to estimate the likelihood of coronary obstruction.

RESULTS: The treating physicians’ estimates of coronary disease likelihood were similar for AA (79.5%) and whites (83.0%); AA were less likely to have any coronary obstruction (63.5% vs. 76.5%, p = 0.05) and had significantly less severe coronary disease (p = 0.01) than whites. African Americans continued to be less likely to have coronary obstruction in analyses controlling for clinical features, including the physician’s estimate of the likelihood of coronary obstruction.

CONCLUSIONS: These results suggest that AA have less coronary obstruction than apparently clinically similar whites. Further studies are required to confirm our findings and better understand the paradox that AA are less likely to have obstructive coronary disease and more likely to suffer mortality from coronary disease.

Abbreviations and Acronyms   AA = African Americans   CAD = coronary artery disease   CDMS = Cardiac Decision Making Study   SAQ = Seattle Angina Questionnaire   VA = Department of Veterans Affairs

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