High Risk | Eastern North Carolina Now

    Publisher's note: This article was originally published by and for ECU News Services.

Race, PAD affect outcome for bypass surgery patients

    A new study by researchers at East Carolina University connects race with a higher chance of death following coronary bypass surgery among patients who also have peripheral artery disease.

    The study, by surgeons and scientists at the Brody School of Medicine at ECU, shows black patients with PAD face a higher risk of death than whites among patients with PAD who undergo coronary artery bypass graft surgery.

    The study is published in the July 2013 issue of The Annals of Thoracic Surgery and is online at http://bit.ly/15P0Gvc.

    PAD is a disease in which plaque builds up in the arteries that carry blood to the head, organs and limbs. One in 20 Americans over the age of 50 has PAD, according to the National Heart, Lung, and Blood Institute.

    Previous research has shown that PAD is more prevalent among blacks; however, the effect of race on long-term survival following CABG surgery had not been examined in this population.

    The study examined the influence of race among patients with peripheral arterial disease who underwent surgery to repair blockages in the arteries that supply blood to the heart, said lead author Dr. Jimmy T. Efird, an epidemiologist and statistician at ECU.

    Using data from the Brody School of Medicine, stored in the Society of Thoracic Surgery National Database, Efird, senior author and surgeon Dr. Alan P. Kypson and colleagues analyzed medical records for 13,053 patients who underwent first-time, isolated CABG at the East Carolina Heart Institute between 1992 and 2011. A total of 1,501 patients (11.5 percent) had PAD at the time of CABG surgery.

    The researchers found that the median survival for patients with PAD was 9.2 years, compared to 15 years for patients without PAD. They also found that while the median survival was 9.5 years for white patients with PAD, it was eight years for black patients with PAD.

    "In an era of personalized medicine and increased focus on quality, one of the ways in which we can significantly improve health care is to critically examine long-term outcomes in different populations in order to narrow the racial disparity gap that we know exists in medicine," said Kypson.

    The East Carolina Heart Institute is in the center of a low-income, rural region with a large black population. Cardiovascular disease is the No. 1 cause of death in North Carolina, with an unequal burden occurring in eastern North Carolina, according to the authors.

    "Our results highlight that the quality and quantity of health care should be extended to all groups for improved overall health and maximization of long-term survival after CABG surgery," said Efird, an associate professor in the ECU Department of Public Health and epidemiologist/chief statistician in the ECU Center for Health Disparities Research. "We recommend that cardiothoracic surgeons and cardiologists continue to closely monitor black patients with PAD after CABG surgery with an understanding that they have an increased long-term risk of death compared with white patients.

    "To a large extent, it is a resource problem," Efird said. "Often black PAD patients will have ambulatory restrictions and may need special transportation to and from their follow-up visits that may not be fully covered by their health insurance or other government programs. Income disparities, fear of the medical system and historic discrimination also may exasperate the situation. The purpose of our outcomes research is to identify the problem so that we can lobby appropriate resources to help reverse racial health disparities in eastern North Carolina."

    Study co-authors were Dr. Wesley T. O'Neal, an ECU medical graduate now at Wake Forest University; his brother Dr. Jason B. O'Neal of Harvard University; and Drs. T. Bruce Ferguson and W. Randolph Chitwood of ECU.

Key Points

    •   For the first time, race — combined with PAD — has been linked to worse outcomes following CABG surgery.

    •   Median survival after CABG for black patients with PAD was eight years compared with 9.5 years for white patients with PAD.

    •   Closer follow-up is recommend for all CABG patients with PAD, but especially black patients with PAD.