Acute myocardial infarction: clinical characteristics, management and outcome in a metropolitan Veterans Affairs Medical Center teaching hospital.
OBJECTIVE
The influence of race and age on thrombolytic therapy, invasive cardiac procedures and outcomes was assessed in a Veterans Affairs teaching hospital. The influence of Q wave evolution on the use of invasive cardiac procedures and outcome was also assessed.


BACKGROUND
It is not well known how early revascularization procedures for acute myocardial infarction are delivered or influence survival in a Veterans Affairs patient population.


METHODS
From October 1993 to October 1995, all patients with myocardial infarction were identified by elevated creatine kinase, MB fraction (CK-MB) and one of the following: chest pain or shortness of breath during the preceding 24 h or electrocardiographic (ECG) abnormalities.


RESULTS
Racial groups were similar in terms of age, time to ECG, peak CK and length of hospital stay. Mortality increased with age (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.33 to 2.81). A trend toward increased mortality occurred for race other than Caucasian. Patients meeting ECG criteria were given thrombolytic agents in 49% of cases, but age, comorbidity count and Hispanic race decreased the probability of thrombolytic use. Cardiac catheterization was performed more often after thrombolytic agents (OR 1.85, 95% CI 0.97 to 3.54), but less often in African-Americans (OR 0.59, 95% CI 0.35 to 1.02), older patients (OR 0.39, 95% CI 0.24 to 0.64) or patients with heart failure (OR 0.30, 95% CI 0.17 to 0.52). Patients evolving non-Q wave infarctions were older and had increased comorbidity counts and trends toward increased mortality. Angioplasty was chosen less for patients > or = 65 years old (p = 0.02); angioplasty and coronary artery bypass graft surgery were performed less in patients > or = 70 years old (p = 0.02). Patients treated invasively had lower mortality rates than those treated medically (p < 0.02).


CONCLUSIONS
The use of thrombolytic agents and invasive treatment plans declined with age, and mortality increased with age. Trends toward increased mortality occurred with non-Q wave infarctions and race other than Caucasian.
Mickelson
J K
JK
Department of Medicine, Baylor College of Medicine, and the Veterans Affairs Medical Center, Houston, Texas 77030, USA.
Blum
C M
CM
Geraci
J M
JM
D001741:Black or African American; D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D004562:Electrocardiography; D006630:Hispanic or Latino; D006784:Hospitals, Teaching; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014481:United States