Udvarhelyi IS. Gatsonis C, Epstein AM, Pashos CL, Newhouse JP, McNeil BJ.
Acute myocardial infarction in the Medicare population. Process of care and clinical outcomes. JAMA 1992;268(18):2530-6.

This retrospective cohort study of patients covered by Medicare in 1987 had three primary objectives: (1) evaluate the use of coronary angiography, coronary artery bypass graft surgery (CABG), and percutaneous transluminal coronary angioplasty (PTCA) in elderly patients with diagnosed Acute Myocardial Infarction (AMI); (2) evaluate outcomes for elderly patients with AMI in terms of mortality, reinfarctions, and reoperations; and (3) examine differences in process of care and outcome by age, gender, and race.

Among other findings, adjusted rates for racial differences in undergoing angiography, CABG, and PTCA were as follows: blacks were 28% less likely to receive catheterization, half as likely to undergo bypass surgery, and 48% less likely to receive angioplasty. The authors found that “even among patients who had undergone angiography, blacks were much less likely to undergo CABG or PTCA (RRs 0.68 and 0.71, respectively).” Mortality rates did not vary by race, however. Blacks had a “slightly better survival at 30 days than did whites (RR, 0.83; 95% CI: 0.80 to 0.86), but the racial differences at two years were not significant.”