Peterson E D, Shaw L K, DeLong E R, Pryor D B, Califf R M, Mark D B
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
N Engl J Med. 1997 Feb 13;336(7):480-6. doi: 10.1056/NEJM199702133360706.
Studies have reported that blacks undergo fewer coronary-revascularization procedures than whites, but it is not clear whether the clinical characteristics of the patients account for these differences or whether they indicate underuse of the procedures in blacks or overuse in whites.
In a study at Duke University of 12,402 patients (10.3 percent of whom were black) with coronary disease, we calculated unadjusted and adjusted rates of angioplasty and bypass surgery in blacks and whites after cardiac catheterization. We also examined patterns of treatment after stratifying the patients according to the severity of disease, angina status, and estimated survival benefit due to revascularization. Finally, we compared five-year survival rates in blacks and whites.
After adjustment for the severity of disease and other characteristics, blacks were 13 percent less likely than whites to undergo angioplasty and 32 percent less likely to undergo bypass surgery. The adjusted black:white odds ratios for receiving these procedures were 0.87 (95 percent confidence interval, 0.73 to 1.03) and 0.68 (95 percent confidence interval, 0.56 to 0.82), respectively. The racial differences in rates of bypass surgery persisted among those with severe anginal symptoms (31 percent of blacks underwent surgery, vs. 45 percent of whites, P<0.001) and among those predicted to have the greatest survival benefit from revascularization (42 percent vs. 61 percent, P<0.001). Finally, unadjusted and adjusted rates of survival for five years were significantly lower in blacks than in whites.
Blacks with coronary disease were significantly less likely than whites to undergo coronary revascularization, particularly bypass surgery - a difference that could not be explained by the clinical features of their disease. The differences in treatment were most pronounced among those predicted to benefit the most from revascularization. Since these differences also correlated with a lower survival rate in blacks, we conclude that coronary revascularization appears to be underused in blacks.
研究报告称，黑人接受冠状动脉血运重建手术的次数少于白人，但尚不清楚患者的临床特征是否能解释这些差异，或者这些差异是否表明黑人对这些手术的使用不足或白人使用过度。
在杜克大学对12402例冠心病患者（其中10.3%为黑人）进行的一项研究中，我们计算了心脏导管插入术后黑人和白人血管成形术和搭桥手术的未调整和调整率。我们还根据疾病严重程度、心绞痛状态以及血运重建预计生存获益对患者进行分层后，研究了治疗模式。最后，我们比较了黑人和白人的五年生存率。
在对疾病严重程度和其他特征进行调整后，黑人接受血管成形术的可能性比白人低13%，接受搭桥手术的可能性比白人低32%。接受这些手术的调整后黑人与白人的比值比分别为0.87（95%置信区间为0.73至1.03）和0.68（95%置信区间为0.56至0.82）。在有严重心绞痛症状的患者中（31%的黑人接受了手术，而白人中有45%，P<0.001）以及预计从血运重建中生存获益最大的患者中（42%对61%，P<0.001），搭桥手术率的种族差异依然存在。最后，黑人未调整和调整后的五年生存率均显著低于白人。
患有冠心病的黑人接受冠状动脉血运重建，尤其是搭桥手术的可能性明显低于白人——这种差异无法用其疾病的临床特征来解释。在预计从血运重建中获益最大的患者中，治疗差异最为明显。由于这些差异也与黑人较低的生存率相关，我们得出结论，冠状动脉血运重建在黑人中似乎未得到充分利用。
