Black-white differences in severity of coronary artery disease among individuals with acute coronary syndromes

Abstract

OBJECTIVE:To determine whether the extent of coronary obstructive disease is similar among black and white patients with acute coronary syndromes. DESIGN:Retrospective chart review. PATIENTS:We used administrative discharge data to identify white and black male patients, 30 years of age or older, who were discharged between October 1, 1989 and September 30, 1995 from 1 of 6 Department of Veterans Affairs (VA) hospitals with a primary diagnosis of acute myocardial infarction (AMI) or unstable angina (UnA) and who underwent coronary angiography during the admission. We excluded patients if they did not meet standard clinical criteria for AMI or UnA or if they had had prior percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. MEASUREMENTS AND MAIN RESULTS:Physician reviewers classified the degree of coronary obstruction from blinded coronary angiography reports. Obstruction was considered significant if there was at least 50% obstruction of the left main coronary artery, or if there was 70% obstruction in 1 of the 3 major epicardial vessels or their main branches. Of the 628 eligible patients, 300 (48%) had AMI. Among patients with AMI, blacks were more likely than whites to have no significant coronary obstructions (28/145, or 19%, vs 10/155 or 7%, P = .001). Similarly, among patients with UnA, 33% (56/168) of blacks but just 17% (27/160) of whites had no significant stenoses (P = .012). There were no racial differences in severity of coronary disease among veterans with at least 1 significant obstruction. Racial differences in coronary obstructions remained after correcting for coronary disease risk factors and characteristics of the AMI. CONCLUSIONS:Black veterans who present with acute coronary insufficiency are less likely than whites to have significant coronary obstruction. Current understanding of coronary disease does not provide an explanation for these differences.KEY WORDS: coronary atherosclerosis; race; acute myocardial infarction; unstable angina; acute coronary syndromes. J GEN INTERN MED 2002;17:876±882. A frican Americans (blacks) do not appear to have shared equally in recent declines in age-adjusted mortality rates due to coronary artery disease (CAD). Whereas there is some evidence that black males had lower coronary artery disease mortality than white men during the 1950s and 1960s, 1±3 more recent data suggest that mortality rates among blacks now exceed those for whites among old and young women, and among men under 65 years of age. 3±5 The reasons for these different trends in mortality rates are unclear. Certain coronary risk factors, including diabetes, obesity, and tobacco use are more prevalent among blacks than whites. 6±9 Alternatively, less extensive use of advanced treatment for coronary artery disease in the black population may contribute to poorer outcomes. This has been most convincingly demonstrated for revascularization procedures. 10±14Despite the high rates of coronary artery disease mortality in the black population, coronary angiographic s...

Prevalence of coronary artery calcium scores and silent myocardial ischaemia was similar in Indian Asians and European whites in a cross-sectional study of asymptomatic subjects from a UK population (LOLIPOP-IPC)

“…This suggests an increased cardiovascular risk among AA compared with NW, irrespective of the detected burden of obstructive coronary artery disease. The lower percentage of obstructive coronary artery disease in AA when compared with NW among patients referred for acute coronary syndromes 33 and lower percentage of coronary stenosis despite higher CHD mortality and prevalence compared with NW, 34,35 lends strength to this argument. It also highlights the importance of factors other than atherosclerotic plaque burden in the prediction of cardiovascular events.…”

Declining Severity of Myocardial Infarction From 1987 to 2002

“…Whittle et al 26 looked at a Veterans Affairs population admitted with acute MI or unstable angina between 1989 and 1995. Among patients with MI who underwent coronary angiography during admission, blacks were more likely than whites to have no significant coronary obstructions, although no information is provided on other severity indicators.…”

Ethnic Differences in the Prognostic Value of Stress Technetium-99m Tetrofosmin Gated Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging

“…*No ischemic heart disease deaths reported. differences in outcome (7,8,(15)(16)(17)(18)(19). For ethnic minority patients, differences with regards to vascular function or vasomotor responsiveness, which are modulated by a patient's risk factor burden, may facilitate higher event risk at any level of obstructive coronary disease burden.…”