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African-American heart attack patients fare worse long term

l numbers of patients or included patients with a wide range of heart disease.

The Duke team chose to focus on a specific group of patients who suffered a kind of heart attack known as an acute ST-elevation myocardial infarction (STEMI). This categorization, based on an electrocardiogram test, is the most severe form of heart attack with the worst short-term outcomes as well as long-term outcomes.

STEMI patients are typically treated quickly in the hospital with clot-busting drugs to restore blood flow to the heart. Many then receive a subsequent angioplasty procedure or coronary artery bypass surgery.

For its analysis, the team pooled data from five different multi-center clinical trials of fibrinolytic, or clot-busting, agents. Of the 32,419 patients in the analysis, 5.1 percent were African-American.

"We found that, when compared to the Caucasian patients, the African-Americans tended to be younger, more likely female, had higher prevalence of cardiovascular risk factors, and were more likely to have higher blood pressure and heart rates," Mehta said. "However, African-Americans also tended to have arteries that responded better to treatment, more likely to have less severe coronary artery disease, and were less likely to have multi-vessel disease."

The researchers found that 6.7 percent of African-Americans had died within thirty days after treatment, compared to 6.6 percent of Caucasian patients. Furthermore, 5 percent of additional African-American patients had died within one year after treatment, compared to 2.9 percent of additional Caucasians.

"What we found particularly intriguing was that African-Americans had worse outcomes despite their average younger age," Mehta continued. The African-Americans were on average 57 years old, compared to 61.1 for Caucasians. "It is well-known that older age is one of the strongest predictors of adverse outcomes for heart attack patients."

The 5.1 percent participa
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Contact: Richard Merritt
Merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
9-Nov-2004


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