Abstract 3867: Racial Differences in the Long Term Survival of Patients with Coronary Artery Disease
Introduction: Cardiovascular disease is the leading cause of death among blacks and whites in the United States. Despite this, there remains a paucity of information on the long-term prognosis of black patients with coronary disease (CAD) as well as the major clinical and treatment-related determinants of their outcome.
Methods: We studied 21,054 patients (3,177 black) having significant CAD findings at cardiac catheterization performed at Duke from January 1986 to December 2004. Using Kaplan Meier and Cox modeling, we compared unadjusted and adjusted long-term survival by patient race (average follow up = 8.4 years) as well as identified major patient characteristics and treatment factors associated with survival.
Results: Blacks with CAD were younger, more often female, had more hypertension, diabetes mellitus, prior myocardial infarction, and congestive heart failure. Disease severity was similar by race. At 15 year follow-up, blacks had significantly lower survival rates than whites (36% vs. 46%, p < 0.001)(Fig⇓). These differences persisted after adjusting for baseline clinical and 30 day percutaneous and surgical coronary revascularization rates; adjusted HR 1.10 (1.03–1.18) p = 0.007.
Conclusion: This analysis represents one of the largest comparisons of long-term outcomes among black and white patients with CAD. Black patients have significantly higher mortality than white patients with a similar extent of CAD. The difference is partially, but not fully explained by differences in co-morbidities and 30 day revascularization rates. Further research is needed to determine the remaining explanations for these persistent racial differences in outcome.