Most studies examining racial disparities in coronary artery disease (CAD) treatment have focused primarily on patients with stable CAD or a diagnosis of myocardial infarction (MI). This prospective study considered the management and outcome of patients with unstable angina or non-Q-wave MI. The inception cohort selected included a specified number of blacks (29% of the sample), women (49%), and elderly patients (age > 75 years) (24.9%) with these acute ischemic syndromes.

The results of this study indicated that black patients were “less likely to be treated with intensive anti-ischemic medication for their qualifying anginal episode” and less likely to
undergo coronary angiography in comparison to non-blacks (risk ratio 0.65; 95% CI, 0.58-0.72,
p<001). However, among those who underwent angiography, blacks had less extensive and severe coronary stenosis than non-blacks. Rates of revascularization were also significantly lower for black patients (OR, 0.44; CI, 0.374-0.523). At hospital discharge, blacks were “less likely to be treated with anti-ischemic or cardioprotective agents such as beta-blockers, aspirin and warfarin sodium,” but they had a lower rate of subsequently recurring ischemia. Black and white rates of death and myocardial infarction were similar.

This study also reports a decreased likelihood of undergoing angiography or receiving revascularization for females and patients aged 75 years or older. However, of these three groups, blacks were less likely to report a recurrent episode of ischemia or die within six weeks after the index event. The authors believe this finding may “not be attributable to differences in medical management, but instead to the presence of less severe disease.”