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CLINICAL STUDIES

Outcome of hispanic patients treated with thrombolytic therapy for acute myocardial infarction

Results from the GUSTO-I and -III trials

Mauricio G. Cohen, MD^a* , Christopher B. Granger, MD^a* , E. Magnus Ohman, MD^a* , Amanda L. Stebbins, MS^a* , Liliana R. Grinfeld, MD^*, Arturo M. Cagide, MD^*, Marcelo V. Elizari, MD, Amadeo Betriu, MD, David F. Kong, MD^a* , Eric J. Topol, MD and Robert M. Califf, MD^a*

^a Duke Clinical Research Institute, Durham, North Carolina, USA
^* Instituto del Corazon, Hospital Italiano, Buenos Aires, Argentina
Ramos Mejia Hospital, Buenos Aires, Argentina
Hospital Clínic, University of Barcelona, Barcelona, Spain
the Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received February 11, 1999; revised manuscript received June 18, 1999, accepted August 18, 1999.

Reprint requests and correspondence: Dr. Mauricio G. Cohen, Box 3375, Duke University Medical Center, Durham, North Carolina 27710
cohen018{at}mc.duke.edu

OBJECTIVES

We sought to describe the differences in the process of care and clinical outcomes between Hispanics and non-Hispanics receiving thrombolytic therapy for myocardial infarction (MI).

BACKGROUND

Hispanics are the fastest growing and second largest minority in the U.S. but most cardiovascular disease data on Hispanics has been derived from retrospective studies and vital statistics. Despite their higher cardiovascular risk-factor profile, better outcomes after MI have been reported in Hispanics.

METHODS

We studied the baseline characteristics, resource use and outcomes of 734 Hispanics and 27,054 non-Hispanics treated for MI in the GUSTO-I and -III trials. The primary end point of both trials was 30-day mortality.

RESULTS

Hispanics were younger, shorter, lighter and more often diabetic and began thrombolysis 9 min later, compared with non-Hispanics. Measures of socioeconomic status (educational level, employment and health insurance) were lower among Hispanics. Fewer Hispanics than non-Hispanics underwent in-hospital angiography (70% vs. 74%, p = 0.013) or bypass surgery (11% vs. 13.5%, p = 0.04). Hispanics received more angiotensin-converting enzyme (ACE) inhibitors and less calcium-channel blockers, prophylactic lidocaine and inotropic agents. Mortality at 30 days and at one year did not differ significantly between Hispanics and non-Hispanics (6.4% vs. 6.7% and 9.0% vs. 9.7%, respectively). We noted no interactions between thrombolytic strategy and Hispanic status on major outcomes (30-day death, stroke and major bleeding).

CONCLUSIONS

The care of Hispanics with MI differed slightly from that of non-Hispanics. Nevertheless, these differences in care did not affect long-term outcomes.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   aPTT = activated partial thromboplastin time   GUSTO-I = Global Utilization of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries   GUSTO-III = Global Use of Strategies To Open Occluded Coronary Arteries   MI = myocardial infarction

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