title: Racial differences among high-risk patients presenting with non-ST-segment elevation acute coronary syndromes (results from the SYNERGY trial).
abstract: Management and outcomes of patients with acute coronary syndromes (ACSs) may vary according to patient race and ethnicity. To assess racial differences in presentation and outcome in high-risk North American patients with non-ST-segment elevation (NSTE) ACS, we analyzed baseline racial/ethnic differences and all-cause death or nonfatal myocardial infarction (MI) in 6,077 white, 586 African-American, and 344 Hispanic patients through 30-day, 6-month, and 1-year follow-up. Frequencies of hypertension were 66% for whites, 83% for African-Americans, and 78% for Hispanics (overall p <0.001). Use of angiography was similar across groups. Use of percutaneous coronary intervention (46% for whites, 41% for African-Americans, and 45% for Hispanics, overall p = 0.046) and coronary artery bypass grafting (20% for whites, 16% for African-Americans, and 22% for Hispanics, overall p = 0.044) differed. African-American patients had significantly fewer diseased vessels compared with white patients (p = 0.0001). Thirty-day death or MI was 14% for whites, 10% for African-Americans, and 14% for Hispanics (overall p = 0.034). After adjustment for baseline variables, African-American patients had lower 30-day death or MI compared with white patients (odds ratio 0.73, 95% confidence interval 0.55 to 0.98). There were no differences in 6-month death or MI across racial/ethnic groups. In conclusion, baseline clinical characteristics differed across North American racial/ethnic groups in the SYNERGY trial. African-American patients had significantly better adjusted 30-day outcomes but similar 6-month outcomes compared with white patients.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina, USA.
authors.forename: Melvin R
authors.initials: MR
authors.lastname: Echols
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Anindita
authors.initials: A
authors.lastname: Banerjee
authors.forename: Karen S
authors.initials: KS
authors.lastname: Pieper
authors.forename: Amanda
authors.initials: A
authors.lastname: Stebbins
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lansky
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.forename: Eric
authors.initials: E
authors.lastname: Velazquez
authors.forename: Renato
authors.initials: R
authors.lastname: Santos
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Enrique P
authors.initials: EP
authors.lastname: Gurfinkel
authors.forename: Luigi
authors.initials: L
authors.lastname: Biasucci
authors.forename: James J
authors.initials: JJ
authors.lastname: Ferguson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
mesh_terms: D000208:Acute Disease; D001741:Black or African American; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000208:ethnology* / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013577:Syndrome; D015912:Thrombolytic Therapy; D044465:White People