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Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry.

Publication ,  Journal Article
Shaw, LJ; Shaw, RE; Merz, CNB; Brindis, RG; Klein, LW; Nallamothu, B; Douglas, PS; Krone, RJ; McKay, CR; Block, PC; Hewitt, K; Weintraub, WS ...
Published in: Circulation
April 8, 2008

BACKGROUND: Although populations referred for coronary angiography are increasingly diverse, there is limited information on coronary artery disease (CAD) prevalence and in-hospital mortality other than for predominately white male patients. METHODS AND RESULTS: We examined gender and ethnic differences in CAD prevalence and in-hospital mortality in a prospective cohort of patients referred for angiographic evaluation of stable angina (n=375,886) or acute coronary syndromes (ACS; unstable angina or myocardial infarction, n=450,329) at 388 US hospitals participating in the American College of Cardiology-National Cardiovascular Data Registry, an angiographic registry. Univariable and multivariable (with covariates that included risk factors, symptoms, and comorbidities) logistic regression models were used to estimate significant CAD, defined as > or = 70% stenosis, and in-hospital mortality. Within stable angina and ACS cohorts, 7% of patients were black, 2% were Hispanic, 0.3% were Native American, 1% were Asian, and 90% were white, respectively. In stable angina, the risk-adjusted OR for significant CAD was 0.34 for women compared with men (P<0.0001), with black women having the lowest risk-adjusted odds (P<0.0001) compared with other females. Among ACS patients, the risk-adjusted OR of significant CAD was 0.47 for women compared with men (P<0.0001); similarly, black women had the lowest risk-adjusted odds (P<0.0001) compared with other females. Higher in-hospital mortality was reported for white women presenting with stable angina (P<0.00001). White women had a 1.34-fold (95% CI 1.21 to 1.48) higher risk-adjusted odds ratio for mortality than white men with stable angina (P<0.0001), with higher rates noted for white women who were older or had significant CAD (both P<0.0001). Lower utilization of elective coronary revascularization, aspirin, and glycoprotein IIb/IIIa inhibitors (all P<0.0001) may have contributed to higher in-hospital mortality for white women. In ACS, higher in-hospital mortality was reported for Hispanic (P=0.015) and white (P<0.0001) women; however, neither white (P=0.51) or Hispanic (P=0.13) women had higher in-hospital risk-adjusted mortality. CONCLUSIONS: The likelihood for significant CAD at coronary angiography and for in-hospital mortality varied significantly by ethnicity and gender. Future clinical practice guidelines should be tailored to gender subsets of the population, in particular for black women, to improve the efficient use of angiographic laboratories and to target at-risk populations of women and men.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

April 8, 2008

Volume

117

Issue

14

Start / End Page

1787 / 1801

Location

United States

Related Subject Headings

  • White People
  • United States
  • Sex Distribution
  • Registries
  • Prospective Studies
  • Prevalence
  • Platelet Aggregation Inhibitors
  • Myocardial Revascularization
  • Middle Aged
  • Male
 

Citation

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Shaw, L. J., Shaw, R. E., Merz, C. N. B., Brindis, R. G., Klein, L. W., Nallamothu, B., … American College of Cardiology-National Cardiovascular Data Registry Investigators, . (2008). Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry. Circulation, 117(14), 1787–1801. https://doi.org/10.1161/CIRCULATIONAHA.107.726562
Shaw, Leslee J., Richard E. Shaw, C Noel Bairey Merz, Ralph G. Brindis, Lloyd W. Klein, Brahmajee Nallamothu, Pamela S. Douglas, et al. “Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry.Circulation 117, no. 14 (April 8, 2008): 1787–1801. https://doi.org/10.1161/CIRCULATIONAHA.107.726562.
Shaw, Leslee J., et al. “Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry.Circulation, vol. 117, no. 14, Apr. 2008, pp. 1787–801. Pubmed, doi:10.1161/CIRCULATIONAHA.107.726562.
Shaw LJ, Shaw RE, Merz CNB, Brindis RG, Klein LW, Nallamothu B, Douglas PS, Krone RJ, McKay CR, Block PC, Hewitt K, Weintraub WS, Peterson ED, American College of Cardiology-National Cardiovascular Data Registry Investigators. Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology-National Cardiovascular Data Registry. Circulation. 2008 Apr 8;117(14):1787–1801.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

April 8, 2008

Volume

117

Issue

14

Start / End Page

1787 / 1801

Location

United States

Related Subject Headings

  • White People
  • United States
  • Sex Distribution
  • Registries
  • Prospective Studies
  • Prevalence
  • Platelet Aggregation Inhibitors
  • Myocardial Revascularization
  • Middle Aged
  • Male