RACE AND PROGNOSIS AFTER MYOCARDIAL-INFARCTION - RESULTS OF THE THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI) PHASE-II TRIAL

Background. To better understand the role of race/ethnicity in surviva l after acute myocardial infarction, we compared clinical and laborato ry data, response to thrombolytic therapy, and clinical outcome in 288 5 patients participating in the Thrombolysis in Myocardial Infarction Phase II (TIMI II) Trial among three groups of patients (2564 whites, 174 blacks, and 147 Hispanics). Methods and Results. Differences were found in baseline characteristics among the three groups including (1) age (mean age for whites, 57.2 years; blacks, 54.8 years; Hispanics, 52.8 years; P<.001), (2) sex (percentage of women for whites, 17.6; bl acks, 28.7; Hispanics, 14.3; P<.001), and (3) risk factor prevalence: current smoking (percent for whites, 49.4; blacks, 62.1; Hispanics, 55 .1; P<.003), history of hypertension (percent for whites, 36.6; blacks , 55.7; Hispanics, 39.5; P<.001), and diabetes mellitus (percent for w hites, 11.9; blacks, 22.4; Hispanics, 19.7; P<.001). Changes in hemost atic factors 5 hours after infusion of recombinant tissue plasminogen activator (rt-PA) revealed a more profound fall in fibrinogen levels i n black patients compared with the response seen in Hispanic or white patients (mean change in fibrinogen +/- SD, mg/dL: 151.3 +/- 107.4, 11 2.2 +/- 97.0, 109.4 +/- 98.6; P <.001, respectively) without more freq uent infarct-related artery patency or hemorrhagic complications. Mort ality was similar in the white, black, and Hispanic patients through t he first year after adjustment for baseline variables. Conclusions. TI MI II data yield evidence that (1) corroborates published reports of a high prevalence of classic cardiovascular risk factors among minority patients with acute myocardial infarction, (2) there is a greater dec rease in fibrinogen levels 5 hours after the start of rt-PA infusion a mong black patients than in white and Hispanic patients without eviden ce of more frequent infarct-related artery patency or hemorrhagic comp lications, and (3) thrombolytic therapy with appropriate supplemental measures is associated with com arable 1-year mortalility in white, bl ack, and Hispanic patients.