Effect of delay on racial differences in thrombolysis for acute myocardial infarction.
OBJECTIVE
To analyze the effect of delay times on racial differences in thrombolysis for acute myocardial infarction.


BACKGROUND
Lower rates of thrombolytic therapy in blacks with acute myocardial infarction have recently been reported, but the reasons for this disparity are unknown. We hypothesized that lower rates of thrombolysis are caused by delay in presentation after symptom onset.


METHODS
From November 1992 through November 1996, consecutive patients with a first acute myocardial infarction presenting to a large, urban teaching hospital were prospectively enrolled. Delay times were determined retrospectively from review of medical records. Patients were prospectively followed up for in-hospital cardiac events and death. A multivariable regression model was built to relate presentation times and other variables to thrombolysis administration.


RESULTS
A total of 395 patients were included in the study, of which 33% were black. Symptom onset to emergency department presentation and door-to-needle times were significantly longer in blacks. Thrombolysis was administered significantly less often in blacks compared with whites (47% vs 68%, P =.001). Black race and age above 60 years were independently associated with delayed presentation and prolonged door-to-needle times. Black race, time to presentation, and non-Q-wave myocardial infarction were independently associated with not receiving thrombolysis. In-hospital mortality rates were similar in both groups.


CONCLUSIONS
Blacks presented later than whites for first acute myocardial infarction. Late arrival strongly influenced the rate of thrombolysis administration. Lower rates of thrombolysis and prolonged door-to-needle times were apparent in blacks after adjustment for delay times and other clinical factors, a finding that merits further investigation.
Syed
M
M
Henry Ford Heart and Vascular Institute, Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, Michigan, USA. masyed1@yahoo.com
Khaja
F
F
Rybicki
B A
BA
Wulbrecht
N
N
Alam
M
M
Sabbah
H N
HN
Goldstein
S
S
Borzak
S
S
D000328:Adult; D044383:Black People; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D011446:Prospective Studies; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D044465:White People; D001741:Black or African American
D005343:Fibrinolytic Agents