Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction - The TIMI III Registry
Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction - The TIMI III Registry
复制标题
DOI：
10.1001/jama.275.14.1104
复制
发表时间：
1996-04-10
影响因子：
120.7
通讯作者：
Braunwald, E
中科院分区：
文献类型：
--
作者：
Stone, PH;Thompson, B;Braunwald, E
客观。-研究不稳定型心绞痛或非Q波心肌梗死（MI）患者的自然病史和治疗反应。初始队列。设置。-一般社区、初级保健或转诊医院的患者。在18家参与医院中，确定并列举了所有发生不稳定劳力性胸痛或静息时胸痛（推测为缺血性起源，持续5分钟或更长时间，但没有持续ST段抬高超过30分钟或出现Q波）的患者。采用特定的抽样策略，选择一个子集的枚举患者进行前瞻性随访，该策略将提供足够数量的黑人、女性和老年患者（年龄大于或等于75岁），以与各自的同行进行比较。主要分析根据人种、性别和年龄比较了进入前瞻性研究后42天的死亡或MI发生率。考虑的其他结果是复发性缺血和死亡，心肌梗死或复发性缺血的综合结果在进入后42天。总共有8676例因不稳定型心绞痛或非Q波心肌梗死入院的患者，其中3318例被选入前瞻性研究。3318例患者的直接校正平均年龄为63.8岁。有943名黑人和2375名非黑人。与非黑人相比，黑人因心绞痛发作而接受强化抗缺血治疗的可能性较小，接受侵入性手术的可能性较小（风险比[RR]，0.65; 95%可信区间[CI]，0.58 - 0.72; P
Objective.-To investigate the natural history and response to treatment of patients with unstable angina or non-Q-wave myocardial infarction (MI).Design.-Inception cohort.Setting.-Patients in general community, primary care, or referral hospitals.Patients.-All patients with an episode of unstable exertional chest pain or chest pain at rest presumed to be ischemic in origin lasting 5 minutes or more but without persisting ST-segment elevation greater than 30 minutes or the development of Q-waves were identified and enumerated in 18 participating hospitals. A subset of enumerated patients was selected to be followed prospectively using specific sampling strategies that would provide adequate numbers of black, women, and elderly (aged greater than or equal to 75 years) patients for comparison with their respective counterparts.Main Outcome Measures.-The primary analysis compared the incidence of death or MI at 42 days after entry into the prospective study according to race, sex, and age. Other outcomes considered were recurrent ischemia and the combined outcomes of death, MI, or recurrent ischemia by 42 days after entry.Results.-A total of 8676 admissions with unstable angina or non-Q-wave MI were enumerated and, of these, 3318 patients were selected for the prospective study. The direct adjusted mean age of the 3318 patients was 63.8 years. There were 943 blacks and 2375 nonblacks. Compared with nonblacks, blacks were less likely to be treated with intensive anti-ischemic therapy for their qualifying anginal episode and less likely to undergo invasive procedures (risk ratio [RR], 0.65; 95% confidence interval [CI], 0.58 to 0.72; P