Williams Marcus Leon, Hill George, Jackson Mary
University of North Carolina at Chapel Hill, North Carolina, USA.
Ethn Dis. 2006 Summer;16(3):653-8.
Historically, African Americans who present with acute myocardial infarction were less likely to survive or be revascularized compared to Whites in the United States. Variation in practice has been implicated as a cause. Some researchers have proposed that the explanation for this variation was that coronary artery disease (CAD) was less severe in African Americans than Whites. A university hospital compared the extent of CAD by race for its acute myocardial infarction (AMI) patients and determined the effect of implementing evidenced-based guidelines on racial differences in cardiovascular outcomes.
From 1991 to 1994, using the National Registry for Myocardial Infarction 1 and the hospital AMI database, 323 of the 521 consecutive patients were catheterized during their initial admission. The extent of CAD was defined as the frequency of CAD stenosis > or =70% seen in the major coronary arteries and/ or their major branches. Cardiac function was measured by left ventricular ejection fraction (LVEF). Short-term hospitalized outcomes were determined for death, treatment, and coronary revascularization.
We assessed 82 (25.4%) African Americans and 241 (74.6%) Whites. No significant difference in the frequency of stenosis > or =70% or clinical outcomes existed between races. However, African Americans had a lower LVEF of 49.13% compared to 54.98% for Whites (P=.04). African Americans were 2.54 times more likely to have LVEF <45% (P=0.024). We saw no racial difference in death, coronary artery bypass graft, percutaneous transluminal coronary angioplasty, or thrombolytic therapy.
In high-risk AMI patients, this study found no difference in the burden of CAD by race. However, for African Americans, left ventricular function was more depressed. The use of an AMI management guideline and pathway-driven protocol resulted in no significant racial difference in cardiac interventions or clinical outcomes. A guideline or protocol-driven approach to the management of AMI may significantly reduce the observed racial
从历史上看，在美国，与白人相比，出现急性心肌梗死的非裔美国人存活或接受血管重建的可能性较小。实践中的差异被认为是一个原因。一些研究人员提出，这种差异的解释是，非裔美国人的冠状动脉疾病（CAD）不如白人严重。一家大学医院比较了其急性心肌梗死（AMI）患者中按种族划分的CAD程度，并确定了实施循证指南对心血管结局种族差异的影响。
1991年至1994年，利用国家心肌梗死注册数据库1和医院AMI数据库，521例连续患者中有323例在首次入院期间接受了导管插入术。CAD的程度定义为在主要冠状动脉和/或其主要分支中出现CAD狭窄≥70%的频率。通过左心室射血分数（LVEF）测量心功能。确定短期住院结局包括死亡、治疗和冠状动脉血管重建。
我们评估了82名（25.4%）非裔美国人和241名（74.6%）白人。种族之间在狭窄≥70%的频率或临床结局方面没有显著差异。然而，非裔美国人的LVEF较低，为49.13%，而白人为54.98%（P = 0.04）。非裔美国人LVEF<45%的可能性是白人的2.54倍（P = 0.024）。我们在死亡、冠状动脉搭桥术、经皮腔内冠状动脉成形术或溶栓治疗方面未发现种族差异。
在高危AMI患者中，本研究发现按种族划分的CAD负担没有差异。然而，对于非裔美国人来说，左心室功能更差。使用AMI管理指南和路径驱动方案在心脏干预或临床结局方面未产生显著的种族差异。采用指南或方案驱动的方法管理AMI可能会显著减少观察到的种族差异。
