Association of Bleeding and In-Hospital Mortality in African American and Caucasian Patients with ST Elevation Myocardial Infarction Receiving Reperfusion
Background—Prior studies have suggested that African Americans with acute ST elevation myocardial infarction (STEMI) have increased bleeding risks with fibrinolysis relative to Caucasians, yet these data were quite limited. Additionally, it is unknown whether there are racial differences in bleeding risks among STEMI patients receiving primary percutaneous coronary intervention (PPCI).
Methods and Results—We evaluate data on African Americans and Caucasians with STEMI treated with either fibrinolysis or PPCI from the National Registry of Myocardial Infarction (NRMI)-4 and 5 participating centers between July 2000 and December 2006. We compared differences between the two groups in rates of in-hospital major bleeding and mortality, adjusted using logistic regression analyses. In fibrinolytic treated STEMI patients, the bleeding rates were higher among African Americans (n=2,283) than Caucasian (n=42,243) (10.9% vs. 10.3%, adjusted OR 1.21, 95% CI 1.02-1.43). Similarly, in patients receiving PPCI, the bleeding rates were higher in African Americans (n=2,826) than Caucasians (n=46,332) (10.3% vs. 7.8%, adjusted OR 1.33, 95% CI 1.13-1.56). Bleeding was associated with higher risk of death in both ethnic groups. However, there was no overall racial difference in the in-hospital mortality among those with bleeding or without bleeding treated with either fibrinolysis or PPCI.
Conclusions—African Americans with STEMI treated with either fibrinolysis or PPCI had higher risk of bleeding events than their Caucasian counterparts. Bleeding was associated with similar increased risk of death in both ethnic groups treated by either reperfusion strategy.
- Received September 16, 2011.
- Accepted February 13, 2012.
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