Peniston R L, Miles N, Lowery R C, Kirkland L, Landes F S, Warner O G, Simmons R L, Janani J, Fletcher J W, Curry C L
J Natl Med Assoc. 1987 Jun;79(6):593-9.
The preoperative profiles of a predominately non-white group of patients undergoing coronary artery bypass grafting were reviewed. Data were obtained from a retrospective analysis of medical records of 163 patients operated on at Howard University Hospital between July 1983 and July 1986. The analysis was carried out primarily to determine whether patients requiring myocardial revascularization were somehow different from their non-black counterparts. Ninety-one percent of the patients were black, 5 percent white, 0.5 percent Hispanic, and 3.5 percent others (Iranian, Filipino, etc).The study was not designed to review the prevalence of coronary disease in blacks, or to determine the natural history following coronary artery bypass grafting, but to determine whether those with established coronary disease of such a severity as to warrant revascularization had the usual clustering of risk factors. Patient records were reviewed to determine the prevalence of hypertension, diabetes, obesity, cigarette smoking, previous myocardial injury, and total serum cholesterol. Because of the well-recognized increased incidence of hypertension in black patients, and its role as a major risk factor in coronary heart disease, the sequelae of hypertension were considered in relation to results of surgical therapy.The study population included 93 men (57 percent) and 70 women (43 percent); mean age was 59 years (fourth to ninth decade). Seventy-four percent of the patients were hypertensive, 35 percent were diabetic, and 77 percent had a smoking history. Obesity was prevalent among the female patients in general, with 36 percent of the diabetics and 21 percent of the nondiabetics being greater than 50 percent over ideal body weight. Ninety percent of the female patients and 80 percent of the male patients presented with New York Heart Association class III or IV angina. Left ventricular function was, on the average, well preserved. The immediate surgical mortality (following exclusion of patients in extremis) was 4 percent. The surgical mortalities were related to easily identifiable factors. Peri-operative infarctions were profoundly influenced by the presence of diabetes.Although this group was distinguished from most reported groups of patients undergoing aortocoronary bypass grafting by the presence of advanced age, the large percentage of women and diabetics and the marked prevalence of hypertension, and the usual risk factors for coronary artery disease reported in the majority population, the study reconfirms previous epidemiologic findings. It appears that racial "clumping" of a heterogeneous non-white population has minimal usefulness, except as it may be related to socioeconomic status and access to quality health care.
对一组主要为非白人的接受冠状动脉搭桥手术患者的术前资料进行了回顾。数据来自于对1983年7月至1986年7月在霍华德大学医院接受手术的163例患者病历的回顾性分析。该分析主要是为了确定需要心肌血运重建的患者是否在某些方面与其非黑人同行有所不同。91%的患者为黑人，5%为白人，0.5%为西班牙裔，3.5%为其他种族（伊朗人、菲律宾人等）。该研究并非旨在回顾黑人中冠心病的患病率，也不是为了确定冠状动脉搭桥术后的自然病程，而是为了确定那些患有严重程度足以进行血运重建的冠心病患者是否具有常见的危险因素聚集情况。查阅患者病历以确定高血压、糖尿病、肥胖、吸烟、既往心肌损伤和总血清胆固醇的患病率。由于黑人患者中高血压发病率明显增加，且其作为冠心病的主要危险因素，因此在考虑手术治疗结果时也考虑了高血压的后遗症。研究人群包括93名男性（57%）和70名女性（43%）；平均年龄为59岁（第四至第九个十年）。74%的患者患有高血压，35%患有糖尿病，77%有吸烟史。肥胖在女性患者中普遍存在，36%的糖尿病女性患者和21%的非糖尿病女性患者体重超过理想体重的50%。90%的女性患者和80%的男性患者表现为纽约心脏协会III级或IV级心绞痛。平均而言，左心室功能保存良好。排除病情危急的患者后，即刻手术死亡率为4%。手术死亡率与易于识别的因素有关。围手术期梗死受糖尿病的显著影响。尽管该组患者与大多数报道的接受主动脉冠状动脉搭桥手术的患者组不同，存在高龄、女性和糖尿病患者比例高以及高血压患病率显著等情况，且具有大多数人群中报道的常见冠状动脉疾病危险因素，但该研究再次证实了先前的流行病学发现。似乎除了可能与社会经济地位和获得优质医疗保健有关外，异质非白人人群的种族“聚集”作用不大。
