Influence of race on death and ischemic complications in patients with non-ST-elevation acute coronary syndromes
Marc S Sabatine1, Gavin J Blake, Mark H Drazner
1TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass 02115. msabatine@partners.org
Circulation
|March 17, 2005
Summary
Nonwhite patients with acute coronary syndromes (ACS) face worse outcomes and disparities in care, even with similar invasive strategies. Early invasive treatment is recommended for all patients, irrespective of race.
Area of Science:
- Cardiology
- Health Services Research
- Health Disparities
Background:
- Nonwhite patients with acute coronary syndromes (ACS) experience worse clinical outcomes compared to white patients.
- Disparities in invasive cardiac procedures for nonwhite patients with ACS are documented.
- The impact of treatment biases on these disparate outcomes remains unclear.
Purpose of the Study:
- To investigate the association between race and clinical outcomes in patients with non-ST-elevation ACS.
- To determine if racial disparities in outcomes persist after adjusting for baseline characteristics.
- To examine treatment patterns and their influence on outcomes in different racial groups.
Main Methods:
- Analysis of data from the Treat Angina with Aggrastat and Determine Cost of Therapy With an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 (TACTICS-TIMI 18) study.
- Comparison of outcomes between 1722 white and 461 nonwhite patients with non-ST-elevation ACS.
- Statistical adjustment for baseline medical characteristics and examination of protocol-guided versus non-protocol-guided care.
Main Results:
- Nonwhite patients had a significantly increased risk of death, myocardial infarction (MI), or rehospitalization for ACS (HR, 1.54; P=0.003) after adjustment.
- Protocol-guided angiography and revascularization rates were similar between racial groups.
- Disparities were observed in non-protocol-guided care, including lower medication adherence and less frequent revascularization procedures for nonwhite patients.
Conclusions:
- Nonwhite patients with ACS have a worse prognosis than white patients, independent of treatment approach.
- Significant disparities in care emerged in the absence of protocol guidance.
- An early invasive strategy is beneficial for all patients with ACS, regardless of race.
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