Abstract 4773: Racial Disparity In Outcomes After CABG Is Not Neutralized By Off Pump Techniques
Introduction: Race has been shown to be an independent risk factor for operative mortality following coronary artery bypass grafting (CABG). This study sought to determine the extent to which race is a risk factor for adverse events and long-term mortality following CABG and whether off-pump surgery (OPCAB) modifies that risk.
Methods: The STS Adult Cardiac Database at a single academic institution was queried for all primary isolated CABG patient records from 1997–2007. A propensity score was formulated based on 51 pre-operative risk factors to balance the patient groups with respect to treatment assignment (OPCAB or CABG on CPB). Multivariable logistic regression was used to assess the impact of African-American (AA) race and OPCAB on in-hospital outcomes (death, stroke, MI, and their composite, MACE). A Cox proportional hazards regression model and Kaplan-Meier curves determined whether AA race impacted long-term all-cause mortality. Interaction terms were constructed to test whether OPCAB surgery produces different results in AA patients than in Caucasian (CAUC) patients.
Results: There were 12,874 consecutive CABG patients, including 2033 (15.8%) AA and 10,841 (84.2%) CAUC patients. AA patients had higher baseline rates of hypertension, diabetes, and renal failure, and suffered higher risk-adjusted incidence of death, stroke and MACE than Caucasian patients.. Risk-adjusted survival at 3, 5, and10 years for AA (87.5%, 81.4%, 63.8%) was significantly lower than for CAUC (90.7%, 85.2%, 67.1%, p<0.001). Both AA patients (AOR 0.77, CI 0.44 –1.36) and CAUC patients (AOR 0.72, CI 0.53– 0.99) who had OPCAB had lower risk-adjusted odds of MACE than their racial counterparts who had CABG on CPB. No interactions existed which suggest that OPCAB has the same effect in AA as it does in CAUC.
Conclusions: OPCAB is similarly beneficial to both race groups in reducing perioperative morbidity. Short and long-term outcomes are significantly worse in AA than Caucasian patients.