Racial/ethnic differences persist in treatment choice and outcomes in isolated intervention for coronary artery disease

Objective: Studies have noted racial/ethnic disparities in coronary artery disease intervention strategies. We investigated trends and outcomes of coronary artery disease treatment choice (coronary artery bypass grafting or percutaneous coro-nary intervention) stratified by race/ethnicity.Methods: We queried the National Inpatient Sample for patients who underwent isolated coronary artery bypass grafting or percutaneous coronary intervention (2002-2017). Outcomes were stratified by race/ethnicity (White, African American, Hispanic, Asian). Multivariable logistic regression evaluated associations between race/ethnicity and receiving coronary artery bypass grafting versus percutaneous coronary intervention, in-hospital mortality, and costs.Results: Over the 15-year period, 2,426,917 isolated coronary artery bypass grafting surgeries and 7,184,515 percutaneous coronary interventions were performed. Compared with White patients, African American patients were younger (62 [inter-quartile range, 53-70] vs 66 [interquartile range, 57-75] years), were more likely to have Medicaid insurance (12.2% vs 4.4%), and had more comorbidities (Charlson-Deyo index, 1.9 +/- 1.6 vs 1.7 +/- 1.6) (all P <.01). After adjustment for patient comor-bidities, presence of acute myocardial infarction, insurance status, and geography, African Americans were the least likely of all racial/ethnic groups to undergo coro-nary artery bypass grafting (odds ratio, 0.76; P <.01), a consistent trend throughout the study. African American patients had higher risk-adjusted mortality after coro-nary artery bypass grafting (odds ratio, 1.09; P <.01). Race/ethnicity was not asso-ciated with increased mortality after percutaneous coronary intervention. African American patients had higher hospitalization costs for coronary artery bypass graft-ing (+$5816; P <.01) and percutaneous coronary intervention (+$856; P <.01) af-ter controlling for confounders.Conclusions: In this contemporary national analysis, risk-adjusted frequency of coronary artery bypass grafting versus percutaneous coronary intervention for cor-onary artery disease differed by race/ethnicity. African American patients had lower odds of undergoing coronary artery bypass grafting and worse outcomes. Reasons for these differences merit further investigation to identify opportunities to reduce potential disparities. (J Thorac Cardiovasc Surg 2023;166:1087-96)