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BMC Health Services Research

, 6:107

First Online: 21 August 2006Received: 24 May 2006Accepted: 21 August 2006DOI: 10.1186-1472-6963-6-107

Cite this article as: Maynard, C., Sun, H., Lowy, E. et al. BMC Health Serv Res 2006 6: 107. doi:10.1186-1472-6963-6-107


BackgroundIt is uncertain whether black white differences in the use of percutaneous coronary intervention PCI persist in the era of drug eluting stents. The purpose of this study is to determine if black veterans with acute myocardial infarction AMI are less likely to receive PCI than their white counterparts.

MethodsThis study included 680 black and 3529 white veterans who were admitted to Veterans Health Administration VHA medical centers between July 2003 and August 2004. Information for this study was collected as part of the VHA External Peer Review Program for quality monitoring and improvement for a variety of medical conditions and procedures, including AMI. In addition, Department of Veterans Affairs workload files were used to determine PCI utilization after hospital discharge. Standard statistical methods including the Chi-square, 2 sample t-test, and logistic regression with a cluster correction for medical center were used to assess the association between race and the use of PCI ≤ 30 days from admission.

ResultsBlack patients were younger, more often had diabetes mellitus, renal disease, or dementia and less often had lipid disorders, previous coronary artery bypass surgery, or chronic obstructive pulmonary disease than their white counterparts. Equal proportions of blacks and whites underwent cardiac catheterization ≤ 30 days after admission, but the former were less likely to undergo PCI 32% vs. 40%, p < 0.0001. This difference persisted after multivariate adjustment, although measures of the extent of coronary artery disease were not available.

ConclusionGiven the equivalent use of cardiac catheterization, it is possible that less extensive or minimal coronary artery disease in black patients could account for the observed difference.

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Autor: Charles Maynard - Haili Sun - Elliott Lowy - Anne E Sales - Stephan D Fihn


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