Differences in the clinical features and outcomes in African Americans and whites with myocardial infarction.
OBJECTIVE
Less is known about the differences in clinical and angiographic features and the outcomes of African Americans with ST-elevation myocardial infarction compared with whites with ST-elevation myocardial infarction. Accordingly, the current study examines the relationship of African American race to patient-related clinical factors, angiographic findings, and clinical events.


METHODS
We evaluated data from 32419 patients with ST-elevation myocardial infarction who received fibrinolysis. The primary outcomes of interest were 30-day and 5-year mortality.


RESULTS
African Americans comprised 5.1% of the study population (1664/32419). Compared with white patients, black patients were younger, were more likely female, had a higher prevalence of coronary risk factors, and were more likely to have higher presenting heart rate, blood pressure, and Killip Class. Coronary angiography rates were similar in the two groups, but blacks were less likely to undergo coronary revascularization. The patency of the infarct-related artery after thrombolysis or mechanical reperfusion was higher in blacks, who were more likely to have no significant coronary artery disease and less likely to have disease in two or more vessels. In-hospital stroke (adjusted odds ratio 1.75, 95% confidence interval [CI] 1.19-2.59) and major bleeding (adjusted odds ratio 1.32, 95% CI 1.13-1.55) were higher among African Americans. Although no differences were observed in the 30-day mortality between the two groups, African Americans who survived to 30 days had higher 5-year mortality than whites (17% vs 12.5%, adjusted hazard ratio 1.63, 95% CI 1.41-1.90).


CONCLUSIONS
Although 30-day survival was similar between African Americans and whites with ST-elevation myocardial infarction, in-hospital stroke and bleeding and 5-year mortality among 30-day survivors were significantly higher among blacks despite their younger age.
Mehta
Rajendra H
RH
Duke Clinical Research Institute, Durham, NC, USA. mehta007@dcri.duke.edu
Marks
David
D
Califf
Robert M
RM
Sohn
SeeHyang
S
Pieper
Karen S
KS
Van de Werf
Frans
F
Peterson
Eric D
ED
Ohman
E Magnus
EM
White
Harvey D
HD
Topol
Eric J
EJ
Granger
Christopher B
CB
D001741:Black or African American; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006470:Hemorrhage / Q000208:ethnology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology; D015996:Survival Rate; D015912:Thrombolytic Therapy; D014481:United States; D044465:White People