Ethnic disparities in outcomes of coronary artery bypass grafting in Israel

OBJECTIVE: Ethnic disparities after cardiac surgery are well reported. Israeli Arabs have lower life expectancy and greater frequency of cardiovascular risk factors. We sought to compare long-term outcomes following coronary artery bypass grafting (CABG) between Arab and Jewish patients in Israel. METHODS: Retrospective study of adult patients with multivessel disease undergoing isolated CABG in three centers between January 1st, 2009, and December 31st, 2023. The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE). The cumulative incidence of MACCE was plotted using KM curves. The hazard ratio (HR) for Arabs vs. Jewish were calculated using multivariate Cox models. RESULTS: Our cohort included 6,330 patients, 1,819 (28.74%) and 4,511 (71.26%) patients were Arabs and Jewish, respectively. Median follow-up time was 78.32 months. Arab patients had higher rate of the primary outcome at median follow-up (46.26% vs 40.90%, HR 1.184, 95%CI: 1.09-1.286, P < 0.001) and there was no difference in mortality between the two groups (26.44% vs 26.45%, HR 1.004, 95%CI: 0.901-1.118, P = 0.82). After multivariable adjustment, the risk of MACCE was similar between the groups (adjusted HR 1.073, 95%CI: 0.965-1.193, P = 0.19). CONCLUSIONS: After multivariable adjustment for baseline and socioeconomic factors, ethnicity was not independently associated with worse long-term clinical outcomes in patients undergoing CABG in Israel, while unadjusted disparities remained evident.