title: Underutilization of reperfusion therapy in eligible African Americans with acute myocardial infarction: Role of presentation and evaluation characteristics.
abstract: BACKGROUND
  Immediate reperfusion therapy to restore coronary blood flow is recommended for all eligible patients with acute myocardial infarction. However, reperfusion therapy is reportedly underutilized among African Americans, even when they are eligible. Reasons for the lack of use have not been fully explored.
  
  
  METHODS
  We examined the demographic, clinical, and treatment data of 10,469 African Americans with acute myocardial infarction who were eligible for reperfusion therapy, enrolled in the National Registry of Myocardial Infarction-2 from June 1994 through March 1998.
  
  
  RESULTS
  The mean age was 62.58 (+/-14.4) years, and 44.7% were female. Although eligible, 47% of the African Americans in this study did not receive reperfusion therapy. In a multivariate analysis, the absence of chest pain at presentation (odds ratio [OR] 0.31, 95% CI 0.26-0.37) and initial admission diagnoses other than definite myocardial infarction (OR for receipt of reperfusion <0.12) were the strongest predictors of lack of early reperfusion therapy. Progressive delays in hospital arrival and hospital evaluation predicted a lower likelihood of early reperfusion. Prior stroke (OR 0.63, 95% CI 0.50-0.78), myocardial infarction (OR 0.75, 95% CI 0.65-0.86), and congestive heart failure (OR 0.49, 95% CI 0.40-0.60) were all associated with lack of reperfusion therapy.
  
  
  CONCLUSIONS
  Almost half of eligible African American patients with myocardial infarction did not receive reperfusion therapy. Potential reasons may include atypical presentation, patient and institutional delay, and underappreciation of myocardial infarction by care providers. Strategies to address these factors may improve the rate of use of reperfusion therapy.
authors.affiliation: Henry Ford Heart and Vascular Institute, Detroit, MI, USA. ajmanhapra@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Manhapra
authors.forename: J G
authors.initials: JG
authors.lastname: Canto
authors.forename: H V
authors.initials: HV
authors.lastname: Barron
authors.forename: J A
authors.initials: JA
authors.lastname: Malmgren
authors.forename: H
authors.initials: H
authors.lastname: Taylor
authors.forename: W J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: W D
authors.initials: WD
authors.lastname: Weaver
authors.forename: N R
authors.initials: NR
authors.lastname: Every
authors.forename: S
authors.initials: S
authors.lastname: Borzak
mesh_terms: D000208:Acute Disease; D001741:Black or African American / Q000706:statistics & numerical data*; D017130:Angioplasty / Q000706:statistics & numerical data; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data* / Q000639:trends; D018579:Patient Selection; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome