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Original Articles

Effect of Race on the Clinical Outcomes in the Bypass Angioplasty Revascularization Investigation Trial

Kathryn Melsop, MS; Maria M. Brooks, PhD; Derek B. Boothroyd, PhD and Mark A. Hlatky, MD

From the Stanford University School of Medicine (K.M., D.B.B., M.A.H.), Stanford, Calif, and the University of Pittsburgh Graduate School of Public Health (M.M.B.), Pittsburgh, Pa.

Correspondence to Mark A. Hlatky, MD, Stanford University School of Medicine, HRP Redwood Building, Room 150, Stanford, CA 94305-5405 E-mail hlatky{at}stanford.edu

Received June 30, 2008; accepted February 24, 2009.

Background— In observational studies, clinical outcomes for black patients with coronary disease have been worse than for white patients. There are few data from randomized trials comparing the outcomes of coronary revascularization between black patients and white patients.

Methods and Results— We analyzed data from the Bypass Angioplasty Revascularization Investigation randomized trial. At study entry, the 113 black patients had significantly higher rates of diabetes, hypertension, smoking, heart failure, and abnormal left ventricular function than the 1653 white patients. Black patients had significantly higher mortality than white patients (hazard ratio, 2.16; P<0.001), which remained significant after statistical adjustment for differences in baseline clinical characteristics (hazard ratio, 1.59; P=0.003). In a substudy of economic and quality of life outcomes, the 67 black patients had similar frequency of physician visits and use of evidence-based cardiac medications but significantly worse physical function scores than the 885 white patients. The effect of random assignment to either surgery or angioplasty on clinical outcomes was not significantly modified by race (interaction probability values 0.18).

Conclusions— Clinical outcomes of black patients after coronary revascularization were worse than those of white patients in a clinical trial setting with similar treatment and access to care. The differences in outcome between black and white patients were not completely attributable to the greater levels of comorbidity among black patients at study entry.

Key Words: coronary disease • treatment outcome • controlled clinical trials, randomized • health policy

The online-only Data Supplement is available at http://circoutcomes.ahajournals.org/cgi/content/full/10.1161/CIRCOUTCOMES.108.802942/DC1.