Long-term implications of racial differences in the use of revascularization procedures (the Myocardial Infarction Triage and Intervention registry).
The purpose of this study was to determine if less intensive use of revascularization procedures in black patients influenced the long-term survival of patients hospitalized for acute myocardial infarction (AMI) in metropolitan Seattle. From January 1988 through June 1994, AMI developed in 420 (4%) black and 10,834 white patients before hospital discharge or death. Black patients were 6 years younger, more socioeconomically disadvantaged, and had more hypertension, diabetes, and less prior coronary surgery. Similar proportions of black and white patients received thrombolytic therapy or cardiac catheterization. However, during hospitalization, 18% of black patients underwent coronary angioplasty compared with 26% of white patients (p = 0.0004); coronary artery bypass surgery was also used less frequently in black patients (7% vs 12%, p = 0.002). Unadjusted 2-year survival was 79% for black patients and 77% for white patients (p = 0.12). After adjusting for age, clinical variables, and the use of cardiac catheterization, thrombolytic therapy, and revascularization, race was not associated with long-term survival (hazard ratio = 0.92, 95% confidence interval = 0.73 to 1.17). Despite the less intensive use of revascularization procedures in black patients in Seattle, long-term survival after AMI was similar in the two groups of patients.
Maynard
C
C
University of Washington, Department of Medicine, Seattle, USA.
Every
N R
NR
Martin
J S
JS
Weaver
W D
WD
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D044383:Black People; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012042:Registries; D012923:Social Class; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D014861:Washington / Q000453:epidemiology; D044465:White People; D001741:Black or African American