Acute myocardial infarction at a university hospital: effect of race on short-term mortality

Several studies have shown that African Americans who have an acute myocardial infarction (AMI) have a higher mortality rate and receive less aggressive cardiac intervention compared with whites. This observational study reports on the in-hospital mortality rate for AMI by race at a university tertiary referral hospital. Racial variation in clinical outcomes and treatment in the area of thrombolysis and acute revascularization was assessed. Data were retrieved from the National Registry on Myocardial Infarction (NRMI) for all 521 patients with AMI admitted to the critical care unit at the University of North Carolina between January 1991 and December 1994. Information collected included age, gender, race, cardiac catheterization results, thrombolytic therapy, coronary bypass surgery, mortality, and arrhythmia. African Americans had a lower in-hospital mortality rate compared with whites (2% versus 8% P < or = 0.03) and were also younger (61 +/- 13 SD versus 64 +/- 12 P = 0.02). Hypertension, diabetes mellitus, or prior myocardial infarction were similar in both groups. Of the 323 patients who received a cardiac catheterization, the extent of coronary disease and left ventricular ejection fraction was similar in both races. Finally, the use of thrombolysis, PTCA, or CABG was not influenced by race. In conclusion, the in-hospital mortality for African Americans at this university tertiary referral center was lower than for whites. This occurred despite a similar incidence in cardiac risk factors and similarly aggressive acute cardiac interventions in both white and African American patients. While African Americans experienced lower in-hospital mortality, this study does not address the pre-hospital and post-hospital risk. It does suggest that African Americans with AMI, who are comparably matched to whites for risk and receive similar cardiac interventions, may have a favorable in-hospital mortality.