Tags

Type your tag names separated by a space and hit enter

Influence of race on death and ischemic complications in patients with non-ST-elevation acute coronary syndromes despite modern, protocol-guided treatment.
Circulation. 2005 Mar 15; 111(10):1217-24.Circ

Abstract

BACKGROUND

In the setting of acute coronary syndromes (ACS), nonwhite patients are less likely to undergo invasive cardiac procedures and may have worse clinical outcomes than white patients. Whether the disparate outcomes exist independently of potential biases in treatment patterns remains unclear.

METHODS AND RESULTS

We examined the association between race and outcome in the Treat Angina with Aggrastat and Determine Cost of Therapy With an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 study (TACTICS-TIMI 18), a randomized trial of invasive versus conservative treatment strategy in patients with non-ST-elevation ACS. There were 1722 white and 461 nonwhite patients. After adjustment for differences in medical characteristics, nonwhite patients were at significantly increased risk for death, MI, or rehospitalization for ACS (hazard ratio [HR], 1.54; P=0.003). Rates of protocol-guided angiography and revascularization were similar in both groups. For non-protocol-guided care, however, we found significant disparities, with nonwhite patients less likely to be taking their cardiac medications at follow-up (odds ratio [OR], 0.59; P=0.0002), to undergo non-protocol-mandated angiography (OR, 0.40; P=0.03), to receive a stent if undergoing percutaneous coronary intervention (OR, 0.55; P=0.045), and to have less procedural success after percutaneous coronary intervention (acute gain, 1.40+/-0.83 versus 1.81+/-0.92 mm; P=0.004). Nonetheless, an invasive strategy was similarly efficacious in white (HR, 0.66; 95% CI, 0.50 to 0.88) and nonwhite (HR, 0.85; 95% CI, 0.52 to 1.39) patients (P(interaction)=0.52), especially in those with troponin elevation or ST deviation.

CONCLUSIONS

After adjustment for baseline characteristics, nonwhite patients had a significantly worse prognosis than white patients, regardless of treatment approach. In the absence of protocol guidance, important disparities emerged between the care given the 2 groups. An early invasive strategy is beneficial in and should be considered for all patients, regardless of race.

Authors+Show Affiliations

TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass 02115. msabatine@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15769761

Citation

Sabatine, Marc S., et al. "Influence of Race On Death and Ischemic Complications in Patients With non-ST-elevation Acute Coronary Syndromes Despite Modern, Protocol-guided Treatment." Circulation, vol. 111, no. 10, 2005, pp. 1217-24.
Sabatine MS, Blake GJ, Drazner MH, et al. Influence of race on death and ischemic complications in patients with non-ST-elevation acute coronary syndromes despite modern, protocol-guided treatment. Circulation. 2005;111(10):1217-24.
Sabatine, M. S., Blake, G. J., Drazner, M. H., Morrow, D. A., Scirica, B. M., Murphy, S. A., McCabe, C. H., Weintraub, W. S., Gibson, C. M., & Cannon, C. P. (2005). Influence of race on death and ischemic complications in patients with non-ST-elevation acute coronary syndromes despite modern, protocol-guided treatment. Circulation, 111(10), 1217-24.
Sabatine MS, et al. Influence of Race On Death and Ischemic Complications in Patients With non-ST-elevation Acute Coronary Syndromes Despite Modern, Protocol-guided Treatment. Circulation. 2005 Mar 15;111(10):1217-24. PubMed PMID: 15769761.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of race on death and ischemic complications in patients with non-ST-elevation acute coronary syndromes despite modern, protocol-guided treatment. AU - Sabatine,Marc S, AU - Blake,Gavin J, AU - Drazner,Mark H, AU - Morrow,David A, AU - Scirica,Benjamin M, AU - Murphy,Sabina A, AU - McCabe,Carolyn H, AU - Weintraub,William S, AU - Gibson,C Michael, AU - Cannon,Christopher P, PY - 2005/3/17/pubmed PY - 2005/10/12/medline PY - 2005/3/17/entrez SP - 1217 EP - 24 JF - Circulation JO - Circulation VL - 111 IS - 10 N2 - BACKGROUND: In the setting of acute coronary syndromes (ACS), nonwhite patients are less likely to undergo invasive cardiac procedures and may have worse clinical outcomes than white patients. Whether the disparate outcomes exist independently of potential biases in treatment patterns remains unclear. METHODS AND RESULTS: We examined the association between race and outcome in the Treat Angina with Aggrastat and Determine Cost of Therapy With an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 study (TACTICS-TIMI 18), a randomized trial of invasive versus conservative treatment strategy in patients with non-ST-elevation ACS. There were 1722 white and 461 nonwhite patients. After adjustment for differences in medical characteristics, nonwhite patients were at significantly increased risk for death, MI, or rehospitalization for ACS (hazard ratio [HR], 1.54; P=0.003). Rates of protocol-guided angiography and revascularization were similar in both groups. For non-protocol-guided care, however, we found significant disparities, with nonwhite patients less likely to be taking their cardiac medications at follow-up (odds ratio [OR], 0.59; P=0.0002), to undergo non-protocol-mandated angiography (OR, 0.40; P=0.03), to receive a stent if undergoing percutaneous coronary intervention (OR, 0.55; P=0.045), and to have less procedural success after percutaneous coronary intervention (acute gain, 1.40+/-0.83 versus 1.81+/-0.92 mm; P=0.004). Nonetheless, an invasive strategy was similarly efficacious in white (HR, 0.66; 95% CI, 0.50 to 0.88) and nonwhite (HR, 0.85; 95% CI, 0.52 to 1.39) patients (P(interaction)=0.52), especially in those with troponin elevation or ST deviation. CONCLUSIONS: After adjustment for baseline characteristics, nonwhite patients had a significantly worse prognosis than white patients, regardless of treatment approach. In the absence of protocol guidance, important disparities emerged between the care given the 2 groups. An early invasive strategy is beneficial in and should be considered for all patients, regardless of race. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15769761/Influence_of_race_on_death_and_ischemic_complications_in_patients_with_non_ST_elevation_acute_coronary_syndromes_despite_modern_protocol_guided_treatment_ L2 - https://www.ahajournals.org/doi/10.1161/01.CIR.0000157733.50479.B9?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -