摘要：Objectives. We examined whether symptoms of coronary heart disease vary between Black and White patients with coronary heart disease, whether presenting symptoms affect physicians’ revascularization recommendations, and whether the effect of symptoms upon recommendations differs in Black and White patients. Methods. We interviewed Black and White patients in Pittsburgh in 1997 to 1999 who were undergoing elective coronary catheterization. We interviewed them regarding their symptoms, and we interviewed their cardiologist decision-makers regarding revascularization recommendations. We obtained coronary catheterization results by chart review. Results. Black and White patients (N=1196; 9.7% Black) expressed similar prevalence of chest pain, angina equivalent, fatigue, and other symptoms, but Black patients had more shortness of breath (87% vs 72%, P =.001). When we considered only those patients with significant stenosis (n=737, 7.1% Black) and controlled for race, age, gender, and number of stenotic vessels, those who expressed shortness of breath were less likely to be recommended for revascularization (odds ratio=0.535; 95% confidence interval=0.375, 0.762; P <.001), but there was no significant interaction with race. Conclusions. Black patients reported shortness of breath more frequently than did White subjects. Shortness of breath was a negative predictor for revascularization for all patients with significant stenosis, but there was no difference in the recommendations by symptom by race. Coronary revascularization interventions are used to relieve the symptoms of individuals with coronary heart disease (CHD) and improve quality of life. 1 , 2 Given that the death rate from CHD is higher in Black individuals, 3 it might be expected that cardiac interventions would be used at least as frequently in Black patients as in White patients. However, numerous studies have documented significantly lower revascularization rates in Black patients, 4 – 7 even when this procedure appears to be clinically indicated. 8 The reasons for this disparity include factors at the patient, provider, and system levels. 7 Some studies suggest that Black patients are more likely to express CHD symptoms other than typical chest pain. 9 Symptom presentation may affect referrals for catheterization or revascularization recommendations. However, the link between race and symptom expression is not well delineated nor is the relation between symptoms and revascularization recommendations. We sought to determine whether there was a difference in CHD subjective symptoms expressed by Black and White patients referred for elective cardiac catheterization and whether symptom differences affected revascularization recommendations. Such information may help to elucidate known racial differences in revascularization rates.
