Abstract 1583: Differences in Bleeding Rates Accounts for All of the Excess Mortality in African Americans Compared With Caucasians With ST-Elevation Myocardial Infarction treated With Fibrinolysis
Background: Prior studies have shown higher bleeding and mortality rates in African Americans (AA) compared with Caucasians with STEMI receiving fibrinolysis. However, the relationship of this excess in bleeding risk to subsequent mortality has not been evaluated.
Methods: We studied STEMI patients receiving fibrinolysis enrolled in 5 trials-GUSTO I, IIb and III and ASSENT-2 and 3 in US. We excluded patients with missing data on race or key baseline characteristics, those treated with primary PCI, and those of races other than Caucasian and AA. End-points included moderate or severe bleeding defined using the GUSTO criteria and 1-year mortality.
Results: Despite their younger age (median 57 vs. 61 yrs) and lower comorbidities, moderate or severe bleeding (16.3% vs. 14.1%, p=0.0147). and 1-year death (11.5% vs. 9.4%, unadjusted HR 1.19, 95% CI 1.02–1.39) occurred more frequently among AA than Caucasians,. The relationship of moderate or severe bleeding to mortality by race is shown in the figure⇓. There was no difference in mortality by race among patients without bleeding. However, mortality was higher in both racial groups with bleeding and the difference in bleeding rates accounted for all of the excess deaths in AA compared with Causcasians.
Conclusions: The excess in 1-year death among AA compared with Caucasian patients with STEMI treated with fibrinolysis appears to be related to the higher rates of bleeding observed in AA. These data highlight the importance of understanding the factors associated with bleeding and represent an opportunity for improving outcomes of all STEMI patients treated with fibrinolysis and potentially for reducing racial disparities in outcomes