Coronary artery bypass grafting in Native Americans
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BACKGROUND: While the efficacy and safety of coronary artery bypass grafting (CABG) has been established in several clinical trials, little is known about its outcomes in Native Americans.
MEASUREMENTS AND MAIN RESULTS: We assessed clinical outcomes associated with CABG in 155 Native Americans using a national database of 18,061 patients from 25 nongovernmental, not-for-profit U.S. health care facilities. Patients were classified into five groups: 1) Native American, 2) white, 3) African American, 4) Hispanic, and 5) Asian. We evaluated for ethnic differences in in-hospital mortality and length of stay, and after adjusting for age, gender, surgical priority, case-mix severity, insurance status, and facility characteristics (volume, location, and teaching status). Overall, we found the adjusted risk for in-hospital death to be higher in Native Americans when compared to whites (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.5 to 9.8), African Americans (OR, 3.4; 95% CI, 1.1 to 9.9), Hispanics (OR, 7.1; 95% CI, 2.5 to 20.3), and Asians (OR, 2.8; 95% CI, 1.1 to 7.0). No significant differences were found in length of stay after adjustment across ethnic groups.
CONCLUSIONS: The risk of in-hospital death following CABG may be higher in Native Americans than in other ethnic groups. Given the small number of Native Americans in the database (n=155), however, further research will be needed to confirm these findings.
- Howard BV, Lee ET, Cowan LD, et al. Coronary heart disease prevalence and its relation to risk factors in American Indians: the Strong Heart Study. Am J Epidemiol. 1995;142:254–8.
- Howard BV, Lee ET, Cowan LD, et al. Rising tide of cardiovascular disease in American Indians: the Strong Heart Study. Circulation. 1999;99:2389–95.
- Lee ET, Cowan LD, Welty TK, et al. All-cause mortality and cardiovascular disease mortality in 3 American Indian populations aged 45 to 74 years, 1984 to 88: the Strong Heart Study. Am J Epidemiol. 1998;147:995–1008.
- Galloway JM, Alpert JS. Coronary artery disease and hypertension. In: Galloway JM, Goldberg BW, Alpert JS, eds. Primary Care of Native American Patients. Boston, Mass: Butterworth-Heineman; 1999:125–32.
- Eagle KA, Guyton RA, Davidoff R, Ewy GA, Fonger J. Guidelines for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 1999;34:1262–347. CrossRef
- Ramsey SD, Saint S, Dey L, Bowdle TA. Costs and outcomes associated with the use of pulmonary artery catheters in elective coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2000;14:113–8. CrossRef
- Iezzoni LI, Ash AS, Shwartz M, Daley J, Hughes JS, Mackernan YD. Judging hospitals by severity-adjusted mortality rates: the influence of the severity-adjusted method. Am J Public Health. 1996;86:1379–87.
- Landon B, Iezzoni LI, Ash AS, et al. Judging hospitals by severity-adjusted mortality rates: the case of CABG surgery. Inquiry. 1996;33:155–66.
- Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, NY: John Wiley & Sons; 1989.
- Hannan EL, Kilburn HJ, Bernard H, O’Donnell JF, Lukacik G, Shields EP. Coronary artery bypass surgery: the relationship between in-hospital mortality rate and surgical volume after controlling for clinical risk factors. Med Care. 1991;29:1094–107. CrossRef
- Rogers WH. Regression standard errors in clustered samples. StataTech Bull. 1993;13:19–23.
- Gray RJ, Nessim S, Khan SS, Denton T, Matloff JM. Adverse 5-year outcome after coronary artery bypass surgery in blacks. Arch Intern Med. 1996;156:769–73. CrossRef
- Verderber A, Castelfrance AM, Nishioka D, Johnson KG. Cardiovascular risk factors and cardiac surgery outcomes in a multiethnic sample of men and women. Am J Crit Care. 1999;8:140–8.
- Alpert J, Goldberg R, Ockene IS, Taylor P. Heart disease in Native Americans. Cardiology. 1991;78:3–12. CrossRef
- Howard BV, Lee ET, Fabsitz RR, et al. Diabetes and coronary heart disease in American Indians. Diabetes. 1996;45(suppl. 3):S6-S13.
- Herlitz J, Wognsen GB, Emanuelsson H, et al. Mortality and morbidity in diabetic and nondiabetic patients during a 2-year period after coronary artery bypass grafting. Diabetes Care. 1996;19:698–703. CrossRef
- Jones RH, Hannan EL, Hammermeister KE, et al. Identification of preoperative variables needed for risk-adjustment of short-term mortality after coronary artery bypass graft surgery: the Working Group Panel on Cooperative CABG Database Project. J Am Coll Cardiol. 1996;28:1478–87. CrossRef
- Boscarino JA, Chang J. Survival after coronary artery bypass graft surgery and community socioeconomic status: clinical and research implications. Med Care. 1999;37:210–6. CrossRef
- U.S. Bureau of the Census. National and State Population Estimates, 1990 to 1994. Washington, DC: U.S. Government Printing Office; 1995.
- Coronary artery bypass grafting in Native Americans
Journal of General Internal Medicine
Volume 16, Issue 8 , pp 554-559
- Cover Date
- Print ISSN
- Online ISSN
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- Native Americans
- coronary artery bypass grafting
- coronary artery disease
- Industry Sectors
- Author Affiliations
- 1. Received from the Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Mich
- 3. the Health Services Research and Development Field Program, VA Ann Arbor Healthcare System, Ann Arbor, Mich
- 4. the Department of Medicine, Oregon Health Sciences University, Portland, Ore
- 5. Solucient, LLC, Bellevue, Wash
- 6. the Department of Medicine, University of Washington, School of Medicine, Seattle, Wash