Influence of Obesity, Race and Gender on Cardiac Catheterization after Stress Testing

Female gender and black race have been associated with lower use of cardiac resources however; these patients also have a higher prevalence of obesity. Therefore we determined their relation to cardiac catheterization after stress testing. Clinical characteristics were determined for all patients stress tested over one year at a safety-net, urban, teaching hospital. Subsequent cardiac catheterizations were identified. Univariate and multivariate analyses were performed to determine the factors associated with catheterization. 3644 patients underwent stress testing and 484 (13%) underwent cardiac catheterization. The population was 58% female, 33% black, 53% were obese and 32% lacked insurance. Obese patients were mostly female, disproportionately black and had more CAD risk factors. An ischemic stress test result was similar across all BMI categories. Obesity was not associated with receipt of catheterization. Although univariate analysis showed fewer catheterizations for female and black patients, multivariate analysis adjusting for stress data and clinical risk factors no longer showed this. Neither race, gender, nor obesity was associated with catheterization utilization when stress testing and clinical factors were considered in a center where financial obstacles to testing were minimized.