Am Heart J 1999 Dec;138(6 Pt 1):1065-72
Racial differences in the management of unstable angina: results from
the multicenter GUARANTEE registry.
Scirica BM, Moliterno DJ, Every NR, Anderson HV, Aguirre FV, Granger CB,
Lambrew CT, Rabbani LE, Sapp SK, Booth JE, Ferguson JJ, Cannon CP.
Harvard Medical School and Brigham and Women's Hospital, Boston, MA,
USA.
BACKGROUND: Prior studies, usually conducted with the
use of insurance databases, have shown differences in the use of cardiac
procedures between black patients and white patients hospitalized with
various types of coronary artery disease. However, few data are available
in prospectively collected cohorts of patients with unstable angina or
on the use of appropriate medications or interventions.
METHODS AND RESULTS: We evaluated 2948 consecutive patients
with unstable angina admitted to 35 hospitals across the United States
in 1996, comparing nonwhite and white patients. Seventy-seven percent
of patients were white, 14% were black, 4% were Hispanic, 1% were Asian,
and 3% were other or unknown race. Differences were seen in coronary risk
profile, with a higher incidence of hypertension and diabetes mellitus
in nonwhites. Cardiac catheterization was performed less often in nonwhites
compared with whites (36% vs 53%, P =.001). Even in patients meeting the
criteria for appropriate catheterization in the Agency for Health Care
Policy Research unstable angina guidelines, fewer nonwhites underwent
catheterization (44% vs 61%, P =.001), but among these, fewer nonwhites
had significant coronary stenosis (72% vs 90%, P =.001). However, among
patients catheterized who had indications for revascularization, angioplasty
and coronary artery bypass grafting were performed equally often in nonwhites
and whites.
CONCLUSIONS: Current guidelines would recommend more
aggressive use of cardiac catheterization for nonwhite patients. However,
our findings suggest that racial differences may need to be included in
the diagnostic and interventional algorithms.
Publication Types: Multicenter Study
PMID: 10577436 [PubMed - indexed for MEDLINE]
