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Heart surgery outcome may be worse in blacks-study

HeartSep 16, 05

The short-term rates of death or heart attack after heart surgery are comparable for blacks and whites, but there is trend toward worse long-term outcomes in blacks, researchers report in the European Heart Journal.

Previous reports have generally described little or no racial gap in the outcome of patients who undergo percutaneous coronary intervention (PCI) to restore blood flow to the heart. PCI typically involves angioplasty, in which a balloon-tipped catheter is snaked into a clogged heart artery to push aside blockages.

However, the investigators point out that various study design issues, such as a lack of long-term follow-up or small sample sizes, may have limited the ability of studies to reach firm conclusions.

To investigate further, Dr. Deepak L. Bhatt, from the Cleveland Clinic Foundation, Ohio and colleagues assessed the long-term outcomes of 8,832 patients who underwent PCI at that institution between 1992 and 2002. The study group included 707 African Americans.

Diabetes was more common among blacks than whites. Black patients also were less likely to have previously undergone a heart procedure, the authors report. PCI was more likely to be urgent in blacks than in whites, but the use of a stent, a device inserted to prop open a blood vessel and prevent re-blockage, was comparable in each group.

Most short-term outcomes, including having a successful procedure and 30-day rates of death or heart attack, were similar for the two groups. The one exception was bleeding around the time of surgery, with a 45-percent higher risk in blacks.

A heart attack occurs when the heart muscle is deprived of oxygen. This causes cells of the heart tissue to die.
What is going on in the body?

Coronary arteries supply blood and oxygen to the heart. When these arteries do not deliver enough oxygen to the heart muscle, pain results. This pain is known as angina. If the heart muscle is deprived of oxygen for a long enough period of time, the heart cells begin to die. This results in a heart attack.

At one-year, the rate of death or heart attack was higher in blacks than in whites, but the difference was not statistically significant, the investigators point out.

The findings, when interpreted in the context of lower procedure rates among African Americans, suggest that continued efforts to optimize the appropriate use of invasive procedures among African Americans with heart disease are warranted.”

SOURCE: European Heart Journal, September 2005.

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