Duke Clinical Research Institute, Box 17969, Durham, NC 27715, USA.
Circulation. 2012 Apr 10;125(14):1727-34. doi: 10.1161/CIRCULATIONAHA.111.068668. Epub 2012 Mar 14.
Prior studies have suggested that blacks with acute ST-segment-elevation myocardial infarction have increased bleeding risks with fibrinolysis relative to whites, yet these data were quite limited. Additionally, it is unknown whether there are racial differences in bleeding risks among patients with ST-segment-elevation myocardial infarction receiving primary percutaneous coronary intervention.
We evaluated data on blacks and whites with ST-segment-elevation myocardial infarction treated with either fibrinolysis or primary percutaneous coronary intervention from the National Registry of Myocardial Infarction (NRMI)-4 and 5 participating centers between July 2000 and December 2006. We compared differences between the 2 groups in rates of in-hospital major bleeding and mortality, adjusted with logistic regression analyses. In fibrinolytic-treated patients with ST-segment-elevation myocardial infarction, the bleeding rates were higher among blacks (n=2283) than whites (n=42 243; 10.9% versus 10.3%; adjusted odds ratio, 1.21; 95% confidence interval, 1.02-1.43). Similarly, in patients receiving primary percutaneous coronary intervention, the bleeding rates were higher in blacks (n=2826) than in whites (n=46 332; 10.3% versus 7.8%; adjusted odds ratio, 1.33; 95% confidence interval, 1.13-1.56). Bleeding was associated with higher risk of death in both ethnic groups. However, there was no overall racial difference in in-hospital mortality among those with bleeding or without bleeding treated with either fibrinolysis or primary percutaneous coronary intervention.
Blacks with ST-segment-elevation myocardial infarction treated with either fibrinolysis or primary percutaneous coronary intervention had a higher risk of bleeding events than their white counterparts. Bleeding was associated with a similar increased risk of death in both ethnic groups treated by either reperfusion strategy.
先前的研究表明，与白人相比，急性 ST 段抬高型心肌梗死的黑人接受溶栓治疗的出血风险更高，但这些数据相当有限。此外，对于接受直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者，其出血风险是否存在种族差异尚不清楚。
我们评估了 2000 年 7 月至 2006 年 12 月期间国家心肌梗死注册（NRMI）-4 和 5 个参与中心的接受溶栓或直接经皮冠状动脉介入治疗的黑人（n=2283）和白人（n=42243）的 ST 段抬高型心肌梗死患者的住院期间主要出血和死亡率数据，并通过 logistic 回归分析进行调整。在接受溶栓治疗的 ST 段抬高型心肌梗死患者中，黑人（n=2283）的出血率高于白人（n=42243；10.9%比 10.3%；调整比值比，1.21；95%置信区间，1.02-1.43）。同样，在接受直接经皮冠状动脉介入治疗的患者中，黑人（n=2826）的出血率也高于白人（n=46332；10.3%比 7.8%；调整比值比，1.33；95%置信区间，1.13-1.56）。两组患者的出血均与死亡风险增加相关。然而，在接受溶栓或直接经皮冠状动脉介入治疗的有出血或无出血的患者中，其住院死亡率并无总体种族差异。
接受溶栓或直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死的黑人患者出血事件的风险高于白人。在接受两种再灌注策略治疗的两组患者中，出血均与死亡风险增加相关。
