Outcome of Hispanic patients treated with thrombolytic therapy for acute myocardial infarction - Results from the GUSTO-I and -III trials

OBJECTIVES We sought to describe the differences in the process of care and clinical outcomes between Hispanics and non-Hispanics receiving thrombolyt ic 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 derive d from retrospective studies and vital statistics. Despite their higher car diovascular risk-factor profile, better outcomes after MI have been reporte d 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 an d began thrombolysis 9 min later, compared with non-Hispanics. Measures of socioeconomic status (educational level, employment and health insurance) w ere 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 i notropic agents. Mortality at 30 days and at one year did not differ signif icantly between Hispanics and non-Hispanics (6.4% vs. 6.7% and 9.0% vs. 9.7 %, respectively). We noted no interactions between thrombolytic strategy an d Hispanic status on major outcomes (30-day death, stroke and major bleedin g). CONCLUSIONS The care of Hispanics with MI differed slightly from that of no n-Hispanics. Nevertheless, these differences in care did not affect long-te rm outcomes. (C) 1999 by the American College of Cardiology.