Johnson P A, Lee T H, Cook E F, Rouan G W, Goldman L
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Ann Intern Med. 1993 Apr 15;118(8):593-601. doi: 10.7326/0003-4819-118-8-199304150-00004.
To compare racial differences in clinical presentation, natural history, and access to medical care and procedures among emergency-department patients with acute chest pain.
Prospective follow-up study of consecutive patients coming to the emergency department because of acute chest pain.
Two university medical centers.
A total of 3031 patients who were 30 years or older and who came to the emergency department with acute chest pain from 1984 to 1986.
African-Americans tended to have slightly, but not always significantly, lower rates of acute myocardial infarction, acute ischemic heart disease, and major complications, after adjusting for presenting symptoms and signs; the adjusted odds ratios for African-Americans were as follows: 0.77 (95% CI, 0.54 to 1.1) for acute myocardial infarction, 0.75 (CI, 0.59 to 0.95) for ischemic heart disease, and 0.79 (CI, 0.45 to 1.4) for death or major complications. Clinical factors classically associated with acute myocardial infarction were equally predictive in African-Americans and whites. After adjustments were made for multiple clinical factors, a lower proportion of African-Americans were admitted to the hospital (odds ratio, 0.69; CI, 0.56 to 0.84), and, once admitted, were somewhat less likely to be triaged to the coronary care unit (odds ratio, 0.81; CI, 0.65 to 1.0). In adjusted analyses, African-Americans were as likely to undergo cardiac catheterization as whites (odds ratio, 0.86; CI, 0.64 to 1.2) but were less likely to undergo coronary artery bypass procedures once severity of coronary disease was included in the analysis (odds ratio, 0.24; CI, 0.08 to 0.71).
African-Americans and whites had a similar presentation and natural history of acute myocardial infarction and, after adjusting for probability of clinical events, similar access to most medical care and cardiac procedures. However, the rate of coronary artery bypass procedures was much lower among African-Americans than among whites. Reasons for this difference should be studied.
比较急诊科急性胸痛患者在临床表现、自然病程以及获得医疗护理和治疗方面的种族差异。
对因急性胸痛前来急诊科的连续患者进行前瞻性随访研究。
两家大学医学中心。
1984年至1986年期间，共有3031名30岁及以上因急性胸痛前来急诊科的患者。
在对就诊症状和体征进行调整后，非裔美国人急性心肌梗死、急性缺血性心脏病和主要并发症的发生率往往略低，但并非总是显著低于白人；非裔美国人的调整后优势比分别如下：急性心肌梗死为0.77（95%可信区间，0.54至1.1），缺血性心脏病为0.75（可信区间，0.59至0.95），死亡或主要并发症为0.79（可信区间，0.45至1.4）。经典的与急性心肌梗死相关的临床因素在非裔美国人和白人中具有同样的预测性。在对多种临床因素进行调整后，非裔美国人住院的比例较低（优势比，0.69；可信区间，0.56至0.84），而且一旦住院，被分诊到冠心病监护病房的可能性也略低（优势比，0.81；可信区间，0.65至1.0）。在调整分析中，非裔美国人接受心脏导管插入术的可能性与白人相同（优势比，0.86；可信区间，0.64至1.2），但在分析中纳入冠心病严重程度后，接受冠状动脉搭桥手术的可能性较小（优势比，0.24；可信区间，0.08至0.71）。
非裔美国人和白人急性心肌梗死的表现和自然病程相似，在对临床事件发生概率进行调整后，获得大多数医疗护理和心脏治疗的机会也相似。然而，非裔美国人冠状动脉搭桥手术的发生率远低于白人。应研究造成这种差异的原因。
