Sánchez-Diaz Carlos Jerjes, García-Badillo Edgar, Sánchez-Ramírez Carlos Jerjes, Juárez Úrsulo, Martínez-Sánchez Carlos
Departamento de Investigación Clínica del Instituto de Cardiología y Medicina Vascular del Tecnológico de Monterrey. Departamento de la Unidad de Investigación Clínica en Medicina SC. Monterrey, N.L., México.
Arch Cardiol Mex. 2012 Jan-Mar;82(1):14-21.
Data regarding management characteristics of non-ST elevation acute coronary syndromes (NSTE ACS) in Mexican, Hispanic and Non- Hispanic white patients are scarce.
We sought to describe the clinical characteristics, process of care, and outcomes of Mexicans, Hispanics and non-Hispanic whites presenting with NSTE ACS at Mexican and US hospitals. We compared baseline characteristics, resource use, clinical practice guidelines (CPGs) compliance and in-hospital mortality among 3 453 Mexicans, 3 936 Hispanics and 90, 280 non-Hispanic whites with NSTE ACS from the RENASICA and CRUSADE registries.
Mexicans were younger with a different cardiovascular risk profile, fewer incidences of hypertension (p<0.001), hyperlipidemia (p<0.001), renal failure (p<0.001) and prior revascularization (p<0.001) but were more likely to be smoking compared with Hispanics and non-Hispanic white populations. Mexicans and Hispanics had a higher incidence of diabetes (p<0.001). At clinical presentation Mexican patients were more likely to have ST depression (p<0.001) but less likely to have left ventricular dysfunction (p<0.001) and troponin stratification (p<0.001). Regarding CPGs compliance, aspirin was used in 90% of patients in all groups, but clopidogrel or unfractionated or low-molecular weight heparin in 50% of patients or less. Mexican patients were less likely to receive glycoprotein IIb/IIIa inhibitors and revascularization. In spite of clinical differences and therapeutic trends, cardiovascular mortality was similar among all groups (Mexicans 4%, Hispanics 4% and non-Hispanic white 5%). In all groups of patients, a poor CPGs compliance was observed.
In a post-hoc analysis, Mexican patients with NSTE ACS had a different cardiovascular risk factor profile and clinical presentation, and less intensive in - hospital treatment than Hispanic and non-Hispanic white patients. However, these differences do not appear to affect in - hospital mortality.
关于墨西哥裔、西班牙裔和非西班牙裔白人患者非ST段抬高型急性冠状动脉综合征（NSTE ACS）管理特征的数据很少。
我们试图描述在墨西哥和美国医院就诊的患有NSTE ACS的墨西哥裔、西班牙裔和非西班牙裔白人的临床特征、治疗过程和结局。我们比较了来自RENASICA和CRUSADE注册库的3453名墨西哥裔、3936名西班牙裔和90280名患有NSTE ACS的非西班牙裔白人患者的基线特征、资源使用情况、临床实践指南（CPG）依从性和住院死亡率。
墨西哥裔患者更年轻，心血管风险状况不同，高血压（p<0.001）、高脂血症（p<0.001）、肾衰竭（p<0.001）和既往血运重建（p<0.001）的发生率较低，但与西班牙裔和非西班牙裔白人相比，吸烟的可能性更大。墨西哥裔和西班牙裔患者的糖尿病发生率较高（p<0.001）。在临床表现方面，墨西哥患者更有可能出现ST段压低（p<0.001），但左心室功能障碍（p<0.001）和肌钙蛋白分层（p<0.001）的可能性较小。关于CPG依从性，所有组中90%的患者使用了阿司匹林，但50%或更少的患者使用了氯吡格雷或普通肝素或低分子量肝素。墨西哥患者接受糖蛋白IIb/IIIa抑制剂和血运重建的可能性较小。尽管存在临床差异和治疗趋势，但所有组的心血管死亡率相似（墨西哥裔4%，西班牙裔4%，非西班牙裔白人5%）。在所有患者组中，均观察到CPG依从性较差。
在一项事后分析中，患有NSTE ACS 的墨西哥患者的心血管危险因素状况和临床表现不同，与西班牙裔和非西班牙裔白人患者相比，住院治疗强度较低。然而，这些差异似乎并未影响住院死亡率。
