Differences in Short-Term Versus Long-term Outcomes of Older Black versus White Patients with Myocardial Infarction: Findings from CRUSADE
Background—Blacks are less likely than whites to receive coronary revascularization and evidence-based therapies following acute myocardial infarction (MI), yet the impact of these differences on long-term outcomes is unknown.
Methods and Results—We linked CRUSADE registry data to national Medicare claims, creating a longitudinal record of care and outcomes among 40,500 non-ST-segment elevation MI (NSTEMI) patients treated at 446 hospitals to examine mortality and readmission rates (mean follow-up 2.4 years) among black and white patients. Relative to whites (n=37,384), blacks (n=3,116) were more often younger and female; more often had diabetes and renal failure; and received less aggressive interventions including cardiac catheterization (60.7% vs. 54.0%, p<0.001), percutaneous coronary intervention (32.1% vs. 23.8%, p<0.001), or coronary bypass surgery (9.2% vs. 5.7%, p<0.001). Though blacks had lower 30-day mortality (9.1% vs. 9.9%, adjusted HR [95% CI]: 0.80 [0.71, 0.92]), they had higher observed mortality at 1 year (27.9% vs. 24.5%, p<0.001), although this was not significant after adjustment on long-term follow-up (HR [95% CI]:1.00 [0.94, 1.07]). Black patients also had higher 30-day (23.6% vs. 20.0%, p<0.001) and 1-year (62.0% vs. 54.6%, p<0.001) all-cause readmission, but these differences were no longer significant after risk adjustment on 30-day (HR [95% CI]: 1.02 [0.92, 1.13]) and long-term (HR [95% CI]: 1.05[1.00, 1.11]) follow-up.
Conclusions—While older blacks with an acute MI had lower initial mortality rates than whites, this early survival advantage did not persist during long-term follow-up. The reasons for this are multifactorial, but may include differences in comorbidities and post-discharge care.
- Received December 19, 2013.
- Revision received May 22, 2014.
- Accepted May 30, 2014.