title: Race, Bleeding, and Outcomes in STEMI Patients Treated with Fibrinolytic Therapy.
abstract: BACKGROUND
  studies have shown higher bleeding and mortality rates among African Americans who receive fibrinolytic therapy for ST-segment elevation myocardial infarction (STEMI) compared with whites; however, the relationship of bleeding risk to mortality has not been evaluated.
  
  
  METHODS
  we studied data from 32,260 STEMI patients receiving fibrinolysis enrolled in the US in 5 clinical trials. Bleeding was defined according to criteria from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries study. Main outcome measure was adjusted 1-year mortality.
  
  
  RESULTS
  despite younger age (median: 57 years vs 61 years) and fewer comorbidities, moderate or severe bleeding occurred more frequently among African-Americans than whites (16.3% vs 14.1%; P=.0147, adjusted OR 1.36; 95% confidence interval [CI], 1.14-1.62; P=.0006) as did 1-year mortality (11.5% vs 9.4%). African-American race and moderate or severe bleeding were independently related to 1-year mortality (χ(2) 9.02, P=.0003 and 148.58, P<.0001, respectively). Mortality was highest among African Americans with bleeding (hazard ratio [HR] 2.83; 95% CI, 2.08-3.86) followed by whites with bleeding (HR 1.99; 95% CI, 1.78-2.22) and African Americans without bleeding (HR 1.33; 95% CI, 1.02-1.73) (referent whites without bleeding).
  
  
  CONCLUSIONS
  in STEMI patients receiving fibrinolysis, moderate or severe bleeding and mortality were significantly higher in African Americans compared with whites. Bleeding was associated with similarly increased mortality risk in both groups.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715, USA. mehta007@dcri.duke.edu
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Amanda
authors.initials: A
authors.lastname: Stebbins
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: Eric R
authors.initials: ER
authors.lastname: Bates
authors.forename: Karen S
authors.initials: KS
authors.lastname: Pieper
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: John H
authors.initials: JH
authors.lastname: Alexander
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
mesh_terms: D001741:Black or African American; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D044465:White People