Outcomes Of Coronary Revascularization Based On Race At A Veterans Affairs Medical Center.
Matthew Skancke1, Jacob Lambdin1, Kendal Endicott1, Jairus Johnson2, Miguel Pinales2, Richard Amdur1, Gregory Trachiotis1.
1George Washington University Hospital, Washington, DC, USA, 2Washington DC Veterans Affairs Medical Center, Washington, DC, USA.
Studies have proven and disproven the impact of a patient’s race on post-operative coronary artery bypass grafting (CABG). The Veteran’s Affairs Medical Center (VAMC) is unique in that it provides easier access to medical care and a robust infrastructure to facilitate post-operative compliance and follow up. This analysis focuses on the impact of race as a predictor of post-operative mortality in patients undergoing CABG at a VAMC.
We reviewed African (AA) and Caucasian American (CA) men who underwent CABG at a single VAMC, by a single surgeon between 2004 and 2016. Comorbid conditions, socioeconomic factors and pre-operative factors of these 753 men were similar. The primary outcome of interest was all-cause mortality at 180 days, 1 year and 5 years. Statistical analysis was performed using independent sample t-tests and binomial regression modeling.
The mean age was 63 years for AA (n=255) and 66 years for CA (n=498, p<0.001) with both receiving an average of one arterial and venous graft. Prior percutaneous catheter intervention, heart surgery and myocardial infarction were similar between cohorts. Cardio-pulmonary bypass time was slightly lower for AA (40 minutes versus 48 minutes, p=0.037). All-cause mortality at 180 days (3.4% versus 3.9% p<0.001) and 1 year (5.9% versus 5.8%, p<0.001) was similar between groups but slightly favored AA at 5 years (17% versus 21%, p<0.001). Regression analysis of race didn’t significant impact overall mortality at 180 days (p=0.56) or 1 year (p=0.713) but trends towards significance at 5 years (HR 0.629, p=0.072). Age had a small impact on overall mortality at 180 days (HR 1.051, p=0.19), 1 year (HR 1.025, p=0.33), with increasing significance on 5 year survival (HR 1.079, p<0.001) following surgery.
Race doesn’t appear to play a large role in all-cause mortality during the first year following cardiac surgery. However, following this cohort to 5 years shows some indication that race may be a risk factor. This may be confounded by the effects of age and the effects of comorbid conditions that do not affect mortality in the 180 day or 1 year period.
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