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Severity of coronary artery disease among blacks with acute myocardial infarction
R Cooper1, A Castaner, A Campo
1Division of Cardiology, Cook County Hospital, Chicago, Illinois 60612-9985.
Insights
Black patients with acute myocardial infarction (AMI) have worse survival, but coronary artery disease (CAD) severity in this study did not fully explain the poor prognosis. Other factors likely contribute to higher mortality after hospital discharge.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Survival rates after acute myocardial infarction (AMI) are significantly lower for Black patients compared to White patients.
- Coronary artery disease (CAD) severity and left ventricular dysfunction are key determinants of survival post-AMI.
Purpose of the Study:
- To investigate if the severity of CAD explains the poorer prognosis observed in Black patients following AMI.
- To assess CAD severity and left ventricular function in a cohort of Black patients after AMI.
Main Methods:
- Cardiac catheterization was performed on 51 Black patients under 70 years old within two weeks of AMI.
- Evaluated coronary artery narrowing, left main stenosis, and left ventricular ejection fraction.
- Echocardiography was used in a subgroup to assess left ventricular mass/height and hypertrophy.
Main Results:
- The study included 51 Black patients (mean age 56, 71% male) within two weeks of AMI.
- Coronary artery disease was present in most patients, with 31% having three-vessel disease. Left main stenosis was found in 6%.
- Mean left ventricular ejection fraction was 55%; 74% showed left ventricular hypertrophy on echocardiogram.
Conclusions:
- Coronary artery disease severity in this cohort of Black patients with AMI was only modestly more severe than anticipated.
- The findings suggest that factors beyond CAD severity likely account for the elevated mortality rates in Black patients post-hospital discharge.
Abstract:
A growing body of evidence suggests that survival after acute myocardial infarction (AMI) is considerably worse among blacks than whites. The severity of coronary artery disease (CAD), as measured by the number of diseased vessels and the degree of left ventricular dysfunction, is the major determinant of survival after AMI. To determine whether or not the severity of CAD could explain the poor prognosis in a cohort of blacks followed at this institution, cardiac catheterization was performed in a consecutive series of 51 patients less than 70 years of age. All patients were studied within 2 weeks after AMI. The mean age of the patients was 56 +/- 8 (mean +/- standard deviation) and 71% were men. A greater than or equal to 50 narrowing in 0, 1, 2 or 3 coronary arteries was noted in 5, 24, 40 and 31%, respectively. Left main stenosis was present in 3 patients (6%) and the mean left ventricular ejection fraction was 55%. In a subgroup of 20 patients echocardiographic estimates of left ventricular mass/height yielded a mean of 196 g/m, and left ventricular hypertrophy on echocardiogram was present in 74%. These data indicate that among blacks with AMI in this series CAD was only modestly more severe than expected and suggest that other factors most likely explain the high mortality in blacks after hospital discharge.