Racial Difference in Symptom Onset to Door Time in ST Elevation Myocardial Infarction.
Racial Difference in Symptom Onset to Door Time in ST Elevation Myocardial Infarction.
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DOI：
10.1161/jaha.116.003804
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发表时间：
2016-09-30
影响因子：
5.4
通讯作者：
Ibebuogu UN
中科院分区：
文献类型：
--
作者：
Bolorunduro O;Smith B;Chumpia M;Valasareddy P;Heckle MR;Khouzam RN;Reed GL;Ibebuogu UN
尽管入院至再灌注时间相当，但与白人患者相比，黑人 ST 段抬高型心肌梗死后的预后较差。我们假设入院延误可能是造成这种情况的原因。我们对 2008 年至 2013 年在我们机构因 STEMI 入院的 1144 名患者进行了回顾性分析。按种族比较了入院到球囊治疗时间 (D2BT) 和症状发作到入院时间 (SODT)。进行双变量分析，比较 D2BT 和 SODT 的中位数。我们进行了分层分析，以评估种族对 D2BT 和 SODT 的影响，并考虑了保险状况、年龄、性别和合并症。平均年龄为 59±13 岁；其中 56% 是黑人，41% 是白人。男性占该人口的66%。 D2BT 中位数为 60 分钟（四分位距 [IQR] 42-82），SODT 中位数为 120 分钟（IQR 60-720）。不同种族的 D2BT 没有显着差异（P=0.86）。黑人患者到急诊室 (ER) 的时间比白人晚（SODT=180 [IQR 60–1400] vs 120 [IQR 60–560] 分钟，P<0.01），并且更有可能没有保险（P<0.01）。在控制合并症、保险和社会经济地位后，黑人在 STEMI 后晚期就诊的可能性高出 60%（OR 1.6，P<0.01）。排除转移患者的子集分析显示了类似的结果。黑人患者在 STEMI 后较晚到急诊室就诊，D2BT 与白人相比没有差异。这种就诊时间的差异可能是导致该人群预后不良的因素之一。
There are poorer outcomes following ST elevation myocardial infarction in blacks compared to white patients despite comparable door‐to‐reperfusion time. We hypothesized that delays to hospital presentation may be contributory. We conducted a retrospective analysis of the 1144 patients admitted for STEMI in our institution from 2008 to 2013. The door‐to‐balloon time (D2BT) and symptom‐onset‐to‐door time (SODT) were compared by race. Bivariate analysis was done comparing the median D2BT and SODT. Stratified analyses were done to evaluate the effect of race on D2BT and SODT, accounting for insurance status, age, sex and comorbidities. The mean age was 59±13 years; 56% of this population was black and 41% was white. Males accounted for 66% of this population. The median D2BT was 60 minutes (interquartile range [IQR] 42–82), and median SODT was 120 minutes (IQR 60–720). There was no significant difference in D2BT by race (P=0.86). Black patients presented to the emergency room (ER) later than whites (SODT=180 [IQR 60–1400] vs 120 [IQR 60–560] minutes, P<0.01) and were more likely to be uninsured (P<0.01). After controlling for comorbidities, insurance, and socioeconomic status, blacks were 60% more likely to present late after a STEMI (OR 1.6, P<0.01). A subset analysis excluding transferred patients showed similar results. Black patients present later to the ER after STEMI with no difference in D2BT compared to whites. This difference in time to presentation may be one of the factors accounting for poor outcomes in this population.