Increased Long-Term Mortality among Black CABG Patients Receiving Preoperative Inotropic Agents
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Definitions
2.3. Setting
2.4. Data Collection and Follow-Up
2.5. Statistical Analysis
3. Results and Discussion
3.1. Results
Characteristic | Inotropes | p-Value * | No Inotropes | p-Value * | ||
---|---|---|---|---|---|---|
Black
n (%) | White
n (%) | Black
n (%) | White
n (%) | |||
Overall | 46 (22) | 165 (78) | – | 2673 (17) | 12881 (83) | – |
Age (Years) | ||||||
Median (IQR) | 68 (20) | 66 (15) | 0.49 | 62 (16) | 65 (15) | <0.0001 |
Female | 20 (43) | 53 (32) | 0.16 | 1131 (42) | 3624 (28) | <0.0001 |
BMI (kg/m2) £ | ||||||
Median (IQR) | 29 (6.8) | 27 (5.7) | 0.019 | 29 (7.5) | 28 (6.6) | <0.0001 |
Ejection fraction (%) £ | ||||||
Median (IQR) | 39 (20) | 35 (25) | 0.21 | 50 (20) | 52 (20) | <0.0001 |
Isolated CABG | 34 (74) | 130 (79) | 0.55 | 2345 (88) | 11265 (87) | 0.72 |
Surgery prior to Year 2001 | 16 (35) | 80 (48) | 0.13 | 1275 (48) | 7503 (58) | <0.0001 |
CAD severity | 0.36 | 0.046 | ||||
1 Vessel | 1 (2)
| 12 (7) | 219 (8) | 1215 (9) | ||
2 Vessel | 12 (26) | 51 (31) | 702 (26) | 3507 (27) | ||
3 Vessel | 33 (72) | 102 (62) | 1752 (66) | 8159 (63) | ||
Left main disease | 9 (20) | 43 (26) | 0.44 | 528 (20) | 2535 (20) | 0.94 |
Recent smoker | 11 (24) | 54 (33) | 0.28 | 680 (25) | 3023 (23) | 0.030 |
Hypertension | 39 (85) | 93 (56) | 0.0005 | 2289 (86) | 8985 (70) | <0.0001 |
Diabetes | 28 (61) | 54 (33) | 0.0004 | 1256 (47) | 4078 (32) | <0.0001 |
Dialysis | 4 (9) | 1 (1) | 0.0085 | 166 (6) | 104 (1) | <0.0001 |
Heart failure ‡ | 26 (57) | 87 (53) | 0.74 | 699 (26) | 2310 (18) | <0.0001 |
Peripheral arterial disease | 12 (26) | 17 (10) | 0.013 | 385 (14) | 1511 (12) | 0.0002 |
Prior MI | 33 (72) | 126 (76) | 0.56 | 1141 (43) | 4822 (37) | <0.0001 |
Prior stroke | 5 (11) | 13 (8) | 0.55 | 302 (11) | 975 (8) | <0.0001 |
Prior PCI | 12 (26) | 54 (33) | 0.47 | 521 (19) | 2463 (19) | 0.67 |
Medications | Inotropes | p-Value * | No Inotropes | p-Value * | ||
---|---|---|---|---|---|---|
Black
n (%) | White
n (%) | Black
n (%) | White
n (%) | |||
Aspirin | 32 (70) | 104 (63) | 0.49 | 1800 (67) | 8891 (69) | 0.090 |
Lipid Lowering Agents | 11 (24) | 45 (27) | 0.71 | 1186 (44) | 5088 (40) | <0.0001 |
β-blockers | 19 (41) | 64 (39) | 0.86 | 1631 (61) | 6940 (54) | <0.0001 |
Anticoagulants | 31 (67) | 116 (70) | 0.72 | 844 (32) | 4026 (31) | 0.75 |
Antiplatelet Agents | 21 (46) | 92 (56) | 0.25 | 1198 (45) | 6542 (51) | <0.0001 |
Calcium Channel Blockers | 8 (17) | 21 (13) | 0.47 | 880 (33) | 3857 (30) | 0.0025 |
Diuretics | 23 (50) | 77 (47) | 0.74 | 814 (30) | 2824 (22) | <0.0001 |
ACE Inhibitors/ARBs | 14 (36) | 54 (33) | 0.86 | 1095 (41) | 3808 (30) | <0.0001 |
Digitalis | 10 (22) | 19 (12) | 0.090 | 180 (7) | 1003 (8) | 0.065 |
Nitrates | 19 (41) | 76 (46) | 0.62 | 356 (13) | 1983 (15) | 0.0062 |
Complications | Inotropes | p-Value * | No Inotropes | p-Value * | ||
---|---|---|---|---|---|---|
Blacks
n (%) | Whites
n (%) | Blacks
n (%) | Whites
n (%) | |||
MI | 0 (0) | 1 (1) | 1.0 | 5 (<1) | 59 (<1) | 0.046 |
Stroke | 0 (0) | 3 (2) | 1.0 | 71 (3) | 184 (1) | <0.0001 |
ARDS | 3 (7) | 15 (9) | 0.77 | 19 (1) | 119 (1) | 0.31 |
Pneumonia | 1 (2) | 16 (10) | 0.13 | 68 (3) | 257 (2) | 0.75 |
Gastrointestinal | 2 (4) | 18 (11) | 0.26 | 103 (4) | 307 (2) | <0.0001 |
Characteristic † | Inotropes | No Inotropes | ||
---|---|---|---|---|
Univariable | Multivariable | Univariable | Multivariable | |
HR (95% CI) | HR (95% CI) | HR (95% CI) | HR (95% CI) | |
Black * | 1.5 (1.004–2.2) | 1.6 (1.009–2.4) | 1.15 (1.08–1.2) | 1.15 (1.08–1.2) |
Age in years (continuous) | 1.04 (1.02–1.06) | 1.04 (1.02–1.1) | 1.057 (1.055–1.060) | 1.054 (1.051–1.057 |
Female | 1.2 (0.82–1.7) | 0.99 (0.68–1.4) | 1.13 (1.07–1.2) | 0.93 (0.88–0.98) |
Hypertension | 1.1 (0.77–1.6) | 0.81 (0.55–1.2) | 1.26 (1.2–1.3) | 1.1 1.07–1.2) |
CAD severity | ||||
1 Vessel | 1.0 Referent | 1.0 Referent | 1.0 Referent | 1.0 Referent |
2 Vessel | 1.1 (0.47–2.7) | 0.92 (0.38–2.2) | 1.2 (1.08–1.3) | 1.2 (1.1–1.4) |
3 Vessel | 1.6 (0.72–3.4) | 1.3 (0.57–3.1) | 1.4 (1.3–1.6) | 1.4 (1.3–1.5) |
Ptrend = 0.048 § | Ptrend = 0.10 § | Ptrend < 0.0001 § | Ptrend < 0.0001 § | |
Heart failure‡ | 1.3 (0.89–1.8) | 1.1 (0.75–1.6) | 2.2 (2.1–2.3) | 1.8 (1.7–2.0) |
Prior stroke | 1.2 (0.65–2.3) | 1.2 (0.62–2.2) | 1.9 (1.8–2.1) | 1.6 (1.5–1.8) |
3.2. Discussion
4. Conclusions
Acknowledgements
Author Contributions
Conflicts of Interest
References
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Efird, J.T.; Griffin, W.F.; Sarpong, D.F.; Davies, S.W.; Vann, I.; Koutlas, N.T.; Anderson, E.J.; Crane, P.B.; Landrine, H.; Kindell, L.; et al. Increased Long-Term Mortality among Black CABG Patients Receiving Preoperative Inotropic Agents. Int. J. Environ. Res. Public Health 2015, 12, 7478-7490. https://doi.org/10.3390/ijerph120707478
Efird JT, Griffin WF, Sarpong DF, Davies SW, Vann I, Koutlas NT, Anderson EJ, Crane PB, Landrine H, Kindell L, et al. Increased Long-Term Mortality among Black CABG Patients Receiving Preoperative Inotropic Agents. International Journal of Environmental Research and Public Health. 2015; 12(7):7478-7490. https://doi.org/10.3390/ijerph120707478
Chicago/Turabian StyleEfird, Jimmy T., William F. Griffin, Daniel F. Sarpong, Stephen W. Davies, Iulia Vann, Nathaniel T. Koutlas, Ethan J. Anderson, Patricia B. Crane, Hope Landrine, Linda Kindell, and et al. 2015. "Increased Long-Term Mortality among Black CABG Patients Receiving Preoperative Inotropic Agents" International Journal of Environmental Research and Public Health 12, no. 7: 7478-7490. https://doi.org/10.3390/ijerph120707478