Document Detail

Effect of delay on racial differences in thrombolysis for acute myocardial infarction.
MedLine Citation:
PMID:  11011340     Owner:  NLM     Status:  MEDLINE    
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.
M Syed; F Khaja; B A Rybicki; N Wulbrecht; M Alam; H N Sabbah; S Goldstein; S Borzak
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American heart journal     Volume:  140     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-10-18     Completed Date:  2000-11-02     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  643-50     Citation Subset:  AIM; IM    
Henry Ford Heart and Vascular Institute, Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, Michigan, USA.
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MeSH Terms
African Continental Ancestry Group*
European Continental Ancestry Group*
Fibrinolytic Agents / therapeutic use*
Hospital Mortality
Middle Aged
Myocardial Infarction / drug therapy*,  ethnology,  mortality
Prospective Studies
Survival Rate
Thrombolytic Therapy* / statistics & numerical data
Time Factors
United States / epidemiology
Urban Population
Grant Support
Reg. No./Substance:
0/Fibrinolytic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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