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(Circulation. 2008;117:1787-1801.)
© 2008 American Heart Association, Inc.

Coronary Heart Disease

Impact of Ethnicity and Gender Differences on Angiographic Coronary Artery Disease Prevalence and In-Hospital Mortality in the American College of Cardiology–National Cardiovascular Data Registry

Leslee J. Shaw, PhD; Richard E. Shaw, PhD; C. Noel Bairey Merz, MD; Ralph G. Brindis, MD; Lloyd W. Klein, MD; Brahmajee Nallamothu, MD; Pamela S. Douglas, MD; Ronald J. Krone, MD; Charles R. McKay, MD; Peter C. Block, MD; Kathleen Hewitt, RN; William S. Weintraub, MD; Eric D. Peterson, MD, MPH, on behalf of the American College of Cardiology–National Cardiovascular Data Registry Investigators

From Emory University (L.J.S., P.C.B.), Atlanta, Ga; Sutter Pacific Heart Centers (R.E.S.), San Francisco, Calif; Cedars-Sinai Medical Center (C.N.B.M.), Los Angeles, Calif; Oakland Medical Center (R.G.B.), Oakland, Calif; Rush University Medical Center (L.W.K.), Chicago, Ill; University of Michigan Medical Center (B.N.), Ann Arbor, Mich; Duke University Medical Center (P.S.D., E.D.P.), Durham, NC; Washington University (R.J.K.), St. Louis, Mo; Harbor-UCLA Medical Center (C.R.M.), Los Angeles, Calif; American College of Cardiology (K.H.), Washington, DC; and Christiana Healthcare (W.S.W.), Wilmington, Del.

Correspondence to Leslee J. Shaw, PhD, Emory Program in Cardiovascular Outcomes Research and Epidemiology, 1256 Briarcliff Rd NE, Suite 1-N, Emory University School of Medicine, Atlanta, GA 30306. E-mail lshaw3{at}emory.edu

Received July 11, 2007; accepted February 8, 2008.

Background— Although populations referred for coronary angiography are increasingly diverse, there is limited information on coronary artery disease (CAD) prevalence and in-hospital mortality other than for predominately white male patients.

Methods and Results— We examined gender and ethnic differences in CAD prevalence and in-hospital mortality in a prospective cohort of patients referred for angiographic evaluation of stable angina (n=375 886) or acute coronary syndromes (ACS; unstable angina or myocardial infarction, n=450 329) at 388 US hospitals participating in the American College of Cardiology–National Cardiovascular Data Registry, an angiographic registry. Univariable and multivariable (with covariates that included risk factors, symptoms, and comorbidities) logistic regression models were used to estimate significant CAD, defined as 70% stenosis, and in-hospital mortality. Within stable angina and ACS cohorts, 7% of patients were black, 2% were Hispanic, 0.3% were Native American, 1% were Asian, and 90% were white, respectively. In stable angina, the risk-adjusted OR for significant CAD was 0.34 for women compared with men (P<0.0001), with black women having the lowest risk-adjusted odds (P<0.0001) compared with other females. Among ACS patients, the risk-adjusted OR of significant CAD was 0.47 for women compared with men (P<0.0001); similarly, black women had the lowest risk-adjusted odds (P<0.0001) compared with other females. Higher in-hospital mortality was reported for white women presenting with stable angina (P<0.00001). White women had a 1.34-fold (95% CI 1.21 to 1.48) higher risk-adjusted odds ratio for mortality than white men with stable angina (P<0.0001), with higher rates noted for white women who were older or had significant CAD (both P<0.0001). Lower utilization of elective coronary revascularization, aspirin, and glycoprotein IIb/IIIa inhibitors (all P<0.0001) may have contributed to higher in-hospital mortality for white women. In ACS, higher in-hospital mortality was reported for Hispanic (P=0.015) and white (P<0.0001) women; however, neither white (P=0.51) or Hispanic (P=0.13) women had higher in-hospital risk-adjusted mortality.

Conclusions— The likelihood for significant CAD at coronary angiography and for in-hospital mortality varied significantly by ethnicity and gender. Future clinical practice guidelines should be tailored to gender subsets of the population, in particular for black women, to improve the efficient use of angiographic laboratories and to target at-risk populations of women and men.

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