Fifteen-Year Trends in Management and Outcomes of Non-ST-Segment-Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000-2014.
Fifteen-Year Trends in Management and Outcomes of Non-ST-Segment-Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000-2014.
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DOI：
10.1161/jaha.118.010203
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发表时间：
2018-10-02
影响因子：
5.4
通讯作者：
Caughey MC
中科院分区：
文献类型：
--
作者：
Arora S;Stouffer GA;Kucharska-Newton A;Vaduganathan M;Qamar A;Matsushita K;Kolte D;Reynolds HR;Bangalore S;Rosamond WD;Bhatt DL;Caughey MC
循证医学治疗的标准化改善了非ST段抬高型心肌梗死（NSTEMI）患者的结局。虽然NSTEMI治疗的种族差异以前曾有报道，但不确定这些差异是否随着时间的推移而改善。ARIC（社区动脉粥样硬化风险）社区监测研究在4个美国社区进行急性心肌梗死的医院监测。使用经验证的算法，通过医生审查对NSTEMI进行分类。从2000年到2014年，ARIC对17755例NSTEMI加权住院患者（患者种族：36%黑人，64%白色）进行了抽样。黑人患者更年轻（60岁对66岁），女性更常见（45%对38%），不太可能有医疗保险（88%对93%），但合并症更多。黑人患者较少使用阿司匹林（85%与92%），其他抗血小板治疗（45%与60%），β受体阻滞剂（85%与88%）和降脂药物（68%与76%）。调整后，黑人患者接受非阿司匹林抗血小板药物的概率降低了24（相对风险：0.76; 95%置信区间，0.71-0.81），血管造影概率降低29%（相对风险：0.71; 95%置信区间，0.67-0.76），血运重建概率降低45%（相对危险度：0.55; 95%置信区间，0.50-0.60）。任何NSTEMI治疗均未观察到随时间变化的趋势（相互作用的P值均>0.20）。对住院NSTEMI患者的纵向社区监测表明，黑人患者有更多的合并症，接受基于指南的NSTEMI治疗的可能性较小，这些结果在15年期间持续存在。有必要集中精力减少合并症负担，并在这一高危人群中更一致地实施指南指导的治疗。
Standardization of evidence‐based medical therapies has improved outcomes for patients with non–ST‐segment–elevation myocardial infarction (NSTEMI). Although racial differences in NSTEMI management have previously been reported, it is uncertain whether these differences have been ameliorated over time. The ARIC (Atherosclerosis Risk in Communities) Community Surveillance study conducts hospital surveillance of acute myocardial infarction in 4 US communities. NSTEMI was classified by physician review, using a validated algorithm. From 2000 to 2014, 17 755 weighted hospitalizations for NSTEMI (patient race: 36% black, 64% white) were sampled by ARIC. Black patients were younger (aged 60 versus 66 years), more often female (45% versus 38%), and less likely to have medical insurance (88% versus 93%) but had more comorbidities. Black patients were less often administered aspirin (85% versus 92%), other antiplatelet therapy (45% versus 60%), β‐blockers (85% versus 88%), and lipid‐lowering medications (68% versus 76%). After adjustments, black patients had a 24% lower probability of receiving nonaspirin antiplatelets (relative risk: 0.76; 95% confidence interval, 0.71–0.81), a 29% lower probability of angiography (relative risk: 0.71; 95% confidence interval, 0.67–0.76), and a 45% lower probability of revascularization (relative risk: 0.55; 95% confidence interval, 0.50–0.60). No suggestion of a changing trend over time was observed for any NSTEMI therapy (P values for interaction, all >0.20). This longitudinal community surveillance of hospitalized NSTEMI patients suggests black patients have more comorbidities and less likelihood of receiving guideline‐based NSTEMI therapies, and these findings persisted across the 15‐year period. Focused efforts to reduce comorbidity burden and to more consistently implement guideline‐directed treatments in this high‐risk population are warranted.