Age, Race, and Gender Variation in the Utilization of Coronary Artery Bypass Surgery and Angioplasty in SHEP

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Abstract
OBJECTIVE: To assess variability in the use of coronary artery bypass grafting (CABG) and percutaneous transluminal angioplasty (PTCA) in the Systolic Hypertension in the Elderly Program (SHEP) cohort with incident coronary heart disease (CHD) by age, sex, and race.DESIGN: Retrospective analysis of a multicenter prospective cohort study.PATIENTS: Among 4736 subjects initially enrolled in SHEP, there were 432 incident cases of CHD, excluding those patients who experienced rapid or sudden cardiac death.SETTING: Community‐based ambulatory population in academic centers.MAIN OUTCOME MEASURE: Incident cases of CHD who underwent CABG or PTCA.RESULTS: Of those participants ≤ 60 and 75 years (P = 0.14). 15.4% of those lt75 underwent CABG surgery, compared with 7.8% of those 75 and older (P = 0.018). When both of these endpoints, CABG and PTCA, were combined, 22.4% of those lt75 underwent a procedure, while only 11.7% of the older cohort did (P = 0.005).Twenty‐six percent of men underwent either CABG or PTCA, while only 9.1% of women did (P < 0.001). Of those CONCLUSION: In the SHEP trial older patients and women, regardless of comorbid conditions, socioeconomic status, and social support, underwent less intensive cardiovascular interventions than did younger patients and men when they developed CHD.