Comparison of Bleeding and In-Hospital Mortality in Asian-Americans Versus Caucasian-Americans With ST-Elevation Myocardial Infarction Receiving Reperfusion Therapy

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• 作者：Rajendra H. Mehta ; MD ; MS^a ; ^{mehta007@dcri.duke.edu} ; Lori Parsons ; BS^b ; Eric D. Peterson ; MD ; MPH^a ; National Registry of Myocardial Infarction Investigators
• 刊名：The American Journal of Cardiology
• 出版年：2012
• 期刊代码：5_00029149
• 类别：med
• 出版时间：1 April, 2012
• 卷：109
• 期：7
• 页码：925-931
• 文件大小：391 K

摘要

Concern has been raised that Asian-Americans may have a higher bleeding risk than Caucasian-Americans when treated with fibrinolytic and antithrombotic agents. To date there is limited evidence to support or refute this hypothesis or evaluate bleeding risk and its related outcomes in Caucasian-Americans versus Asian-Americans with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PPCI). We evaluated Asian-Americans and Caucasian-Americans with STEMI receiving reperfusion therapy in the National Registry of Myocardial Infarction (NRMI) 4 and 5 (n = 90,317). We studied risk-adjusted major bleeding and in-hospital mortality. Major bleeding rates after fibrinolysis were similar in Asian-Americans (n = 705) and Caucasian-Americans (n = 42,243, 11.1%vs 10.3%, adjusted odds ratio [OR] 0.97, 95%confidence interval [CI] 0.69 to 1.36, p = 0.5002). Although the observed major bleeding rate was higher in Asian-Americans (n = 1,037) compared to Caucasian-Americans (n = 46,332) treated with PPCI (10.3%vs 7.8%, p = 0.0036), these rates differed only marginally after adjusting for baseline clinical variables (OR 1.24, 95%CI 0.97 to 1.59). Overall adjusted mortality was similar in Asian-Americans and Caucasian-Americans when treated with fibrinolysis (OR 0.96, 95%CI 0.56 to 1.65) or with PPCI (OR 1.35, 95%CI 0.85 to 2.13). Major bleeding after PPCI or fibrinolysis was associated with similar increased risks for mortality in these ethic groups. In conclusion, despite suggestions to the contrary, Asian-Americans with STEMI treated with fibrinolysis or PPCI had similar bleeding and bleeding-related mortality risks compared to Caucasian-Americans. Given the genotypic and phenotypic differences between the 2 cohorts, similar studies in the rapidly growing Asian-American population are needed to confirm our findings and to understand the safety and effectiveness of newer potent antiplatelet and antithrombotic agents in patients with coronary syndromes.