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Peer-reviewedCC BY 4.0PLOS One

Ethnic disparities in outcomes of coronary artery bypass grafting in Israel

  • Dror B. Leviner1
  • Tom Ronai2
  • Dana Abraham3
  • Ely Erez4
  • Guy Witberg5
  • Yaron Yishai6
  • Joul Haddad7
  • Erez Sharoni
7 affiliations
  1. 1Department of Cardiothoracic surgery, Rabin Medical Center, Petach Tikve, Haifa, Israel
  2. 2Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
  3. 3Department of Cardiothoracic surgery, Carmel Medical Center, Israel
  4. 4Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America
  5. 5Department of Cardiology, Rabin Medical Center, Petach Tikve, Israel
  6. 6Department of Cardiothoracic Surgery, Soroka Medical Center, Beer Sheba, Israel
  7. 7Department of Biostatistics, Carmel Medical Center, Haifa, Israel
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{leviner2026ethnic,
  title = {{Ethnic disparities in outcomes of coronary artery bypass grafting in Israel}},
  author = {Dror B. Leviner and Tom Ronai and Dana Abraham and Ely Erez and Guy Witberg and Yaron Yishai and Joul Haddad and Erez Sharoni},
  journal = {PLOS One},
  year = {2026},
  month = nov,
  doi = {10.1371/journal.pone.0356423},
  url = {https://doi.org/10.1371/journal.pone.0356423},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Ethnic disparities in outcomes of coronary artery bypass grafting in Israel
AU  - Dror B. Leviner
AU  - Tom Ronai
AU  - Dana Abraham
AU  - Ely Erez
AU  - Guy Witberg
AU  - Yaron Yishai
AU  - Joul Haddad
AU  - Erez Sharoni
PY  - 2026
DA  - 2026/11/06
JO  - PLOS One
DO  - 10.1371/journal.pone.0356423
UR  - https://doi.org/10.1371/journal.pone.0356423
AB  - 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.
SN  - 1932-6203
ER  -