Outcome of Hispanic patients treated with thrombolytic therapy for acute myocardial infarction: results from the GUSTO-I and III trials. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries.
OBJECTIVE
We sought to describe the differences in the process of care and clinical outcomes between Hispanics and non-Hispanics receiving thrombolytic therapy for myocardial infarction (MI).


BACKGROUND
Hispanics are the fastest growing and second largest minority in the U.S. but most cardiovascular disease data on Hispanics has been derived from retrospective studies and vital statistics. Despite their higher cardiovascular risk-factor profile, better outcomes after MI have been reported in Hispanics.


METHODS
We studied the baseline characteristics, resource use and outcomes of 734 Hispanics and 27,054 non-Hispanics treated for MI in the GUSTO-I and -III trials. The primary end point of both trials was 30-day mortality.


RESULTS
Hispanics were younger, shorter, lighter and more often diabetic and began thrombolysis 9 min later, compared with non-Hispanics. Measures of socioeconomic status (educational level, employment and health insurance) were lower among Hispanics. Fewer Hispanics than non-Hispanics underwent in-hospital angiography (70% vs. 74%, p = 0.013) or bypass surgery (11% vs. 13.5%, p = 0.04). Hispanics received more angiotensin-converting enzyme (ACE) inhibitors and less calcium-channel blockers, prophylactic lidocaine and inotropic agents. Mortality at 30 days and at one year did not differ significantly between Hispanics and non-Hispanics (6.4% vs. 6.7% and 9.0% vs. 9.7%, respectively). We noted no interactions between thrombolytic strategy and Hispanic status on major outcomes (30-day death, stroke and major bleeding).


CONCLUSIONS
The care of Hispanics with MI differed slightly from that of non-Hispanics. Nevertheless, these differences in care did not affect long-term outcomes.
Cohen
M G
MG
Duke Clinical Research Institute, Durham, North Carolina, USA. cohen018@mc.duke.edu
Granger
C B
CB
Ohman
E M
EM
Stebbins
A L
AL
Grinfeld
L R
LR
Cagide
A M
AM
Elizari
M V
MV
Betriu
A
A
Kong
D F
DF
Topol
E J
EJ
Califf
R M
RM
D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013300:Streptokinase / Q000627:therapeutic use; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase