Lower thrombolytic use for African Americans with myocardial infarction: An influence of clinical presentation?

Background After myocardial infarction, African Americans hove been reporte d to undergo fewer catheterization and revascularization procedures than wh ites, but few studies have addressed racial variations in the delivery of t hrombolytic therapy. Methods we conducted a retrospective analysis of data prospectively collect ed on consecutive patients admitted with acute myocardial infarction to the 16-bed coronary care unit of a large, urban reaching hospital. Results Over a 5-year period, 1948 consecutive patients were admitted with acute myocardial infarction to a single coronary care unit. Thrombolysis wa s administered to 19% of 1024 African Americans and 29% of 924 whites (P < .01). The initial diagnostic impression on admission was "definite" infarct ion less often in African Americans (30%) than in whites (43%, P < .001), a difference that appeared to largely account for the difference in thrombol ytic administration in a multivariable model. Mortality adjusted for age an d concomitant illnesses was similar in African Americans compared with whit es (relative risk 1.0, 95% confidence interval 0.78 to 1.51). Conclusions Much of the racial variation in thrombolytic administration cou ld be accounted for by differences in clinical presentation, an issue that requires further study.