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Biomedical subjects

W D Weaver

Publications and source records attributed to W D Weaver.

At least 91 records · Page 5Linked to original sources
PubMed1996

Length of hospital stay after acute myocardial infarction in the Myocardial Infarction Triage and Intervention (MITI) Project registry.

OBJECTIVES: This study sought to identify current trends in length of stay in patients with an acute myocardial infarction and to evaluate which demographic, clinical, procedural and hospital-related factors explain the variation and reduction in length of stay observed during the study period. BACKGROUND: Hospital length of stay is an important contribution to cost of care. Previous studies of length of stay after acute myocardial infarction have been performed largely on administrative data bases and do not reflect current practice patterns. METHODS: We used univariate and multivariate models to evaluate which demographic, clinical and administrative factors influenced length of stay in 11,932 patients with acute myocardial infarction admitted to 19 Seattle-area hospitals between 1988 and 1994. RESULTS: Length of hospital stay decreased from (mean +/- SD) 8.5 +/- 8.2 to 6.0 +/- 5.8 days during the study period. Demographic and clinical characteristics known at the time of admission explained only 6% of variation in length of stay, whereas hospital complications, procedure use and type of admitting hospital explained an additional 27% of variation. The use of primary angioplasty and early diagnostic coronary angiography predicted a shorter length of stay; however, none of the measured variables explained the 29% reduction in length of stay that occurred between 1988 and 1994. CONCLUSIONS: Although hospital complications, procedure use and hospital characteristics are important predictors of length of hospital stay, none of these factors explains the 29% reduction in length of stay observed in postmyocardial infarction patients between 1988 and 1994. It is likely that unmeasured economic and administrative factors play important roles in influencing hospital length of stay.

Aged↗
PubMed1996

Results of the RAPID 1 and RAPID 2 thrombolytic trials in acute myocardial infarction.

Two angiographic trials, RAPID 1 in 606 patients and RAPID 2 in 324 patients, assessed angiographic patency after acute myocardial infarction following treatment with reteplase and alteplase. RAPID 1 evaluated three bolus regimens of reteplase in comparison with a 3 h infusion of alteplase. RAPID 2 compared the 10 MU + 10 MU double bolus regimen of reteplase with the accelerated regimen (90 min infusion) of alteplase. The results of these studies showed that reteplase opened more arteries more quickly than did alteplase. Angiography at both 60 and 90 min showed a higher rate of patency and greater TIMI (Thrombolysis in Myocardial Infarction perfusion grade) 3 flow rates with reteplase than with alteplase. In RAPID 1, at 90 min, TIMI 3 flow rates were 63% for reteplase compared to 49% for alteplase (P < 0.05), and in RAPID 2, TIMI 3 flow was 60% vs 45%, respectively, (P < 0.05). Reteplase was convenient and simple to administer, and there were no unexpected complications. Fewer interventional procedures were performed after therapy with reteplase than with alteplase, primarily because coronary angioplasty was required less frequently following acute angiography in patients receiving reteplase. The angiographic profile for reteplase demonstrated in these two trials suggests that this new thrombolytic drug has potential advantages over alteplase: notably, its use can result in earlier and more complete coronary patency. The clinical significance of this finding must be determined in larger clinical trials.

Adolescent↗
PubMed1996

The role of thrombolytic drugs in the management of myocardial infarction. Comparative clinical trials.

Optimal thrombolytic therapy in acute myocardial infarction must aim to achieve early and complete reperfusion of the infarct related coronary artery. Establishment of normal coronary flow (Thrombolysis in Myocardial Infarction [TIMI] grade 3) is the key correlate of improved survival. Three large-scale clinical trials, the Reteplase Angiographic Phase II International Dose-finding Study (RAPID 1), the Reteplase vs Alteplase Patency Investigation During Acute Myocardial Infarction Study (RAPID 2), and the International Joint Comparison of Thrombolytics Study (INJECT), have evaluated the comparative efficacy and safety of reteplase, a new, rapid-acting thrombolytic agent that offers the practical clinical convenience of bolus dosing. RAPID 1 and 2 demonstrated that reteplase was associated with superior early coronary artery patency rates compared with alteplase, whether alteplase was infused over 3 h or over 90 min. Further, the TIMI 3 flow rates achieved in reteplase-treated patients at 60 min were comparable to those achieved at 90 min with the accelerated alteplase dosing regimen. The INJECT trial showed that reteplase resulted in comparable mortality and clinical benefits to those achieved with streptokinase. All three studies demonstrated that reteplase therapy was not associated with an increase in bleeding complications or other adverse clinical events. The simple double-bolus regimen of reteplase administration may permit earlier initiation of thrombolysis with fewer dosing errors than with continuous infusion regimens and thus afford a reduction in the morbidity and mortality risks in patients with acute myocardial infarction.

Controlled Clinical Trials as Topic↗
PubMed1995

The influence of clinical risk factors on the use of angiography and revascularization after acute myocardial infarction. Myocardial Infarction Triage and Intervention Project Investigators.

BACKGROUND: Coronary revascularization provides the greatest survival advantage in those patients with the greatest mortality risk. This study examines the relationship between variables that predict mortality and the use of angiography and revascularization after acute myocardial infarction. METHODS: Study of 4823 survivors of acute myocardial infarction, who underwent angiography between 6 hours and 5 days of admission, to determine the relationship between factors that predict mortality and the use of angiography (n = 2274), angioplasty (n = 692), and bypass surgery (n = 469). RESULTS: Except for recurrent angina, clinical factors that predict higher mortality were associated with a lower use of angiography (the multivariable adjusted odds ratio was 0.47 for older age, 0.85 for a history of infarction, 0.50 for patients not receiving thrombolytic medications, 0.64 for new heart failure, and 2.75 for recurrent angina [P < .001 for all factors]). A similar relationship was observed among patients selected for angioplasty (the odds ratio was 0.51 for an ejection fraction of < 40%, 0.72 for those patients not receiving thrombolytic medications, 0.74 for a history of infarction, and 1.94 for recurrent angina [P < .001 for all factors]). In contrast, patients with unfavorable prognostic profiles were much more likely to undergo coronary bypass surgery (the odds ratio was 1.46 for recurrent angina, 1.28 for older age groups, 2.23 for new heart failure, 1.28 for patients not receiving thrombolytic medications, and 1.46 for a history of infarction [P < .001 for all factors]). CONCLUSIONS: These data suggest that aside from symptoms of recurrent angina, the use of angiography and angioplasty is not driven by mortality risk stratification. In contrast, bypass surgery is preferentially performed in patients at increased risk for mortality.

Age Factors↗
PubMed1995

Stroke after thrombolysis. Mortality and functional outcomes in the GUSTO-I trial. Global Use of Strategies to Open Occluded Coronary Arteries.

BACKGROUND: Stroke is the most feared complication of thrombolysis for acute myocardial infarction because of the resulting mortality and disability. We analyzed the incidence, timing, and outcomes of stroke in an international trial. METHODS AND RESULTS: Patients were randomly assigned to one of four thrombolytic strategies. Neurological events were confirmed clinically and anatomically and were adjudicated by a blinded committee. Stroke survivors, categorized by residual deficit and disability, assessed their quality of life with a time trade-off technique. Multivariable regression identified patient characteristics associated with intracranial hemorrhage. Over-all, 1.4% of the patients had a stroke (93% anatomic documentation). The risk ranged from 1.19% with streptokinase/subcutaneous heparin therapy to 1.64% with combination thrombolytic therapy (P = .007). Primary intracranial hemorrhage rates ranged from 0.46% with streptokinase/subcutaneous heparin to 0.88% with combination therapy (P < .001). Of all strokes, 41% were fatal, 31% were disabling, and 24% were nondisabling, with no significant treatment-related differences. Stroke subtype affected prognosis: 60% of patients with primary intracranial hemorrhage died and 25% were disabled versus 17% dead and 40% disabled with nonhemorrhagic infarctions. Patients with moderate or severe residual deficits showed significantly decreased quality of life. Advanced age, lower weight, prior cerebrovascular disease or hypertension, systolic and diastolic blood pressures, randomization to tissue plasminogen activator, and an interaction between age and hypertension were significant predictors of intracranial hemorrhage. CONCLUSIONS: Stroke remains a rare but catastrophic complication of thrombolysis. Additional studies should assess the net clinical benefit of thrombolysis in high-risk subgroups, particularly the elderly and patients with prior cerebrovascular events.

Aged↗
PubMed1995

Factors influencing the time to administration of thrombolytic therapy with recombinant tissue plasminogen activator (data from the National Registry of Myocardial Infarction). Participants in the National Registry of Myocardial Infarction.

Very early administration of thrombolytic therapy for acute myocardial infarction (AMI) has significantly reduced mortality in eligible patients. The purpose of this study was to evaluate factors which influenced the time from symptom onset to hospital presentation and the time from hospital presentation to the onset of thrombolytic treatment in a large population of patients with AMI. This study included 212,990 patients from 904 hospitals that participated in the National Registry of Myocardial Infarction. The median time from symptom onset to hospital presentation for those treated was 1.5 hours versus 2.7 hours for those not receiving thrombolytic treatment. Older patients and women had increased delay times, as did those who arrived at the hospital during daytime hours. Of the 59,802 (28%) patients who received thrombolytic treatment, 23% were treated < 30 minutes from admission; 63%, < 60 minutes; and 83%, < 90 minutes. Time to treatment increased with age and was longer for women and for patients arriving between midnight and early morning. The most important factor associated with shorter time to treatment was the initiation of thrombolytic treatment in the emergency department rather than in the coronary care unit (47 vs 73 minutes, p < 0.0001). Hospital treatment times are much too long, given that quick identification and treatment of eligible patients are of primary importance in reducing mortality from AMI. To shorten these times, thrombolytic treatment should be initiated in the emergency department, and the effectiveness of hospital programs aimed at reducing time to treatment should be subject to continuing quality improvement surveillance.

Aged↗
PubMed1995

Regional variation across the United States in the management of acute myocardial infarction. GUSTO-1 Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries.

BACKGROUND: Differences in the management of acute myocardial infarction have been reported among countries, but few studies have investigated this issue in regions of the United States. METHODS: We compared the management of acute myocardial infarction among census regions across the United States, using data from the first Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries trial (GUSTO-1) comprising 21,772 patients, and from the American Hospital Association. RESULTS: We found substantial regional variation in the management of acute myocardial infarction in the United States. Beta-blockers (prescribed for a range of 55 to 81 percent of patients in the various regions), nitrates (prescribed for 61 to 77 percent), and angiotensin-converting-enzyme inhibitors (prescribed for 18 to 23 percent) were used most often in New England, whereas calcium-channel blockers (31 to 42 percent) and lidocaine (14 to 43 percent) were used least often there. Similarly, the proportion of patients undergoing various cardiac procedures differed among regions (range for angiography, 52 to 81 percent of patients; angioplasty, 22 to 35 percent; and coronary-artery bypass surgery, 9 to 17 percent) and was lowest in New England. The regional use of cardiac procedures was closely related to their availability, except in New England. After the analysis was adjusted for clinical and hospital variables, patients in New England were found to be less likely to undergo angiography than patients in the other regions (odds ratio, 0.37; 95 percent confidence interval, 0.32 to 0.42). There was no apparent relation between the use of cardiac procedures and rates of recurrent infarction or death at 30 days or 1 year. CONCLUSIONS: There is substantial regional variation in the use of cardiac medications and procedures to manage acute myocardial infarction in the United States. The use and availability of cardiac procedures are closely related. The management of acute myocardial infarction in New England is atypical in that the relatively limited availability of cardiac procedures does not account for their relatively low use in that region.

Angioplasty↗
PubMed1995

Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators.

BACKGROUND: Despite remarkable advances in the treatment of acute myocardial infarction, substantial early patient mortality remains. Appropriate choices among alternative therapies and the use of clinical resources depend on an estimate of the patient's risk. Individual patients reflect a combination of clinical features that influence prognosis, and these factors must be appropriately weighted to produce an accurate assessment of risk. Prior studies to define prognosis either were performed before widespread use of thrombolysis or were limited in sample size or spectrum of data. Using the large population of the GUSTO-I trial, we performed a comprehensive analysis of relations between baseline clinical data and 30-day mortality and developed a multivariable statistical model for risk assessment in candidates for thrombolytic therapy. METHODS AND RESULTS: For the 41,021 patients enrolled in GUSTO-I, a randomized trial of four thrombolytic strategies, relations between clinical descriptors routinely collected at initial presentation, and death within 30 days (which occurred in 7% of the population) were examined with both univariable and multivariable analyses. Variables studied included demographics, history and risk factors, presenting characteristics, and treatment assignment. Risk modeling was performed with logistic multiple regression and validated with bootstrapping techniques. Multivariable analysis identified age as the most significant factor influencing 30-day mortality, with rates of 1.1% in the youngest decile (< 45 years) and 20.5% in patients > 75 (adjusted chi 2 = 717, P < .0001). Other factors most significantly associated with increased mortality were lower systolic blood pressure (chi 2 = 550, P < .0001), higher Killip class (chi 2 = 350, P < .0001), elevated heart rate (chi 2 = 275, P < .0001), and anterior infarction (chi 2 = 143, P < .0001). Together, these five characteristics contained 90% of the prognostic information in the baseline clinical data. Other significant though less important factors included previous myocardial infarction, height, time to treatment, diabetes, weight, smoking status, type of thrombolytic, previous bypass surgery, hypertension, and prior cerebrovascular disease. Combining prognostic variables through logistic regression, we produced a validated model that stratified patient risk and accurately estimated the likelihood of death. CONCLUSIONS: The clinical determinants of mortality in patients treated with thrombolytic therapy within 6 hours of symptom onset are multifactorial and the relations complex. Although a few variables contain most of the prognostic information, many others contribute additional independent prognostic information. Through consideration of multiple characteristics, including age, medical history, physiological significance of the infarction, and medical treatment, the prognosis of an individual patient can be accurately estimated.

Aged↗
PubMed1995

Appearance of abnormal Q waves early in the course of acute myocardial infarction: implications for efficacy of thrombolytic therapy.

OBJECTIVES: The purpose of this study was to determine the time course of the appearance of abnormal Q waves on the electrocardiogram (ECG) over the first 6 h of symptoms of myocardial infarction and to determine what implications, if any, such Q waves have for the efficacy of thrombolytic therapy. BACKGROUND: Severe myocardial ischemia can produce early QRS changes in the absence of infarction. Abnormal Q waves on the baseline ECG may not be an accurate marker of irreversibly injured myocardium. METHODS: Data from 695 patients who had no past history of myocardial infarction and whose admission ECG allowed prediction of myocardial infarct size in the absence of thrombolytic therapy (Aldrich score) were pooled from four prospective trials of thrombolytic therapy. The presence and number of abnormal Q waves on each patient's initial ECG were recorded. Four hundred thirty-six patients had left ventricular infarct size measured using quantitative thallium-201 tomography a mean (+/- SD) of 52 +/- 43 days after admission. RESULTS: Of patients admitted within 1 h of symptoms, 53% had abnormal Q waves on the initial ECG. Both predicted and final infarct size were larger in patients with abnormal Q waves on the initial ECG independent of the duration of symptoms before therapy (p < 0.001). Despite this finding, the presence of abnormal Q waves on the admission ECG did not eliminate the effect of thrombolytic therapy on reducing final infarct size (p < 0.0001). CONCLUSIONS: Abnormal Q waves are a common finding early in the course of acute myocardial infarction. However, there is no evidence that abnormal Q waves are associated with less benefit in terms of reduction of infarct size after thrombolytic therapy.

Electrocardiography↗
PubMed1995

Time to thrombolytic treatment: factors affecting delay and their influence on outcome.

One of the major limitations to realizing the full potential of the lifesaving effects of thrombolytic therapy has been the failure to initiate treatment in the first 1 to 1.5 h after symptom onset. The barriers to early treatment include the following: 1) Most patients fail to react rapidly and appropriately to symptoms. 2) Few emergency medical/paramedic systems have established effective triage systems for patients with chest pain or have implemented prehospital electrocardiography to better manage patients with possible acute myocardial infarction. 3) Time to treatment after hospital arrival currently averages 1 to 1.5 h-two to three times longer than what should be necessary to initiate therapy in the patient with typical electrocardiographic and clinical findings and co-morbid risk factors. Trials evaluating the effects of prehospital-initiated therapy have all shown trends toward a reduction in mortality (18%) associated with early treatment; however, none has been large enough in and of itself to be conclusive. The goal in the coming years will be to decrease each of these components of delay by developing effective education programs for the lay public, speeding and improving prehospital care by the routine use of electrocardiography and reducing hospital treatment times to < or = 30 min in the "uncomplicated" patient.

Emergency Medical Services↗
PubMed1995

Sequential combination thrombolytic therapy for acute myocardial infarction: results of the Pro-Urokinase and t-PA Enhancement of Thrombolysis (PATENT) Trial.

OBJECTIVES: The present study was designed to test the efficacy and safety of a sequential combination of recombinant tissue-type plasminogen activator (rt-PA) and pro-urokinase in patients with acute myocardial infarction. BACKGROUND: Efforts continue to identify a thrombolytic regimen that induces rapid, complete and sustained coronary artery patency in acute myocardial infarction. The two endogenous plasminogen activators rt-PA and pro-urokinase have been shown experimentally to induce fibrinolysis by sequential and complementary mechanisms. As a result, certain combinations of these activators have been found to be synergistic in vitro and in vivo. METHODS: In a multicenter observational study with core facilities for angiographic and laboratory analysis, 101 patients with acute myocardial infarction were enrolled and given a low dose bolus of rt-PA (5 to 10 mg) followed by a 90-min infusion of pro-urokinase (40 mg/h). All patients received intravenous heparin and oral aspirin. Coronary angiography was performed in all patients at 90 min. RESULTS: Angiography at 90 min showed the infarct-related artery to be patent (Thrombolysis in Myocardial Infarction [TIMI] grade 2 or 3 flow) in 77% of patients, and 60% achieved TIMI grade 3 flow. At one center, angiography was repeated at 24 h to detect a possible reocclusion. All 28 patients with a patent infarct-related artery at 90 min had patency at 24 h (82% achieved TIMI grade 3 flow). Treatment was well tolerated, with bleeding complications essentially confined to arterial puncture site hematomas. There was only one in-hospital death. CONCLUSIONS: A sequential combination of low dose rt-PA and reduced-dose pro-urokinase produced a high TIMI 3 patency rate, was well tolerated and was associated with a low reocclusion rate.

Adult↗
PubMed1995

Resource utilization in treatment of acute myocardial infarction: staff-model health maintenance organization versus fee-for-service hospitals. The MITI Investigators. Myocardial Infarction Triage and Intervention.

OBJECTIVES: This study sought to compare the use of invasive procedures and length of stay for patients admitted with acute myocardial infarction to health maintenance organization (HMO) and fee-for-service hospitals. BACKGROUND: The HMOs have reduced costs compared with fee-for-service systems by reducing discretionary admissions and decreasing hospital length of stay. It has not been established whether staff-model HMO hospitals also reduce the rate of procedure utilization. METHODS: Using data from a retrospective cohort, we performed univariate and multivariate comparisons of the use of cardiac procedures, length of stay and hospital mortality in 998 patients admitted to two staff-model HMO hospitals and 7,036 patients admitted to 13 fee-for-service hospitals between January 1988 and December 1992. RESULTS: The odds of undergoing coronary angiography were 1.5 times as great for patients admitted to fee-for-service hospitals than for those admitted to HMO hospitals (odds ratio 1.5, 95% confidence interval [CI] 1.3 to 1.9). Similarly, the odds of undergoing coronary revascularization were two times greater in fee-for-service hospitals (odds ratio 2.0, 95% CI 1.6 to 2.5). However, higher utilization was strongly associated with the greater availability of on-site cardiac catheterization facilities in fee-for-service hospitals. The length of hospital stay, by contrast, was approximately 1 day shorter in the fee-for-service cohort (7.3 vs. 8.0 days, p < 0.05). CONCLUSIONS: Physicians in staff-model HMO hospitals use fewer invasive procedures and longer lengths of stay to treat patients with acute myocardial infarction than physicians in fee-for-service hospitals. This finding, however, appears to be associated with the lack of on-site catheterization facilities at HMO hospitals.

Aged↗
PubMed1995

ECG findings in acute myocardial infarction. Are there sex-related differences?

Women with acute myocardial infarction are less likely than men to receive thrombolytic therapy. It is not known whether sex-related differences in the presenting 12-lead electrocardiogram (ECG) account for this relative underutilization of acute reperfusion therapy in women. The authors examined the initial ECGs of 188 men and 185 women matched for age and history of previous acute myocardial infarction randomly selected from the Myocardial Infarction Triage and Intervention registry who presented with 4 hours of confirmed acute myocardial infarction. There were no sex-related differences in the number of leads with ST elevation, the presence of diagnostic ST elevation, or the overall magnitude of ST elevation. In addition, there was no sex-related difference in associated ECG findings that might effect physicians' utilization of acute reperfusion therapy, including the location of ST elevation (anterior vs inferior), the presence of abnormal Q waves in leads with ST elevation, the association of ST depression with ST elevation (reciprocal changes), or the presence of confounding factors, such as bundle branch block or hypertrophy. Differences in the presenting ECG do not explain the underutilization of acute reperfusion therapy in women.

Aged↗
PubMed1995

Primary coronary angioplasty in hospitals with and without surgery backup. MITI project investigators.

In the Myocardial Infarction Triage and Intervention (MITI) project, a registry of acute myocardial infarction, 1,062 patients were treated for acute myocardial infarction using primary coronary angioplasty. Of those, 470 (44%) received the procedure in hospitals without coronary surgery capability on-site. These patients were compared to 592 (56%) other patients treated in hospitals with on-site surgery. Most baseline characteristics of patients treated by primary angioplasty were similar in the two types of centers. ST segment elevation was present in 76% of patients; time from admission to angiography averaged 100 +/- 71 minutes (median 77 minutes). There was no difference in procedural success rate nor initial and long-term mortality rates in patients treated by primary angioplasty in the two types of hospitals. The mortality rate at discharge for patients treated by primary coronary angioplasty was 7% in both types of hospitals. In the subset of patients with ST segment elevation and no evidence of shock and no prior bypass surgery, 30 day mortality rates were 7% and 8% (p = 0.46), respectively. In a multivariable analysis of those factors influencing survival, age, a history of prior myocardial infarction, and anterior ST elevation but not the availability of on-site surgical backup, was associated with outcome. In summary, this observational study suggests that with appropriate patient selection, trained operators, and a provision for hospital transfer, primary coronary angioplasty can be accomplished in centers without on-site surgery with acceptable outcomes.

Adult↗
PubMed1995

Streamlining the triage system for acute myocardial infarction.

The full benefits of thrombolytic therapy can be realized if and only if treatment is delivered as quickly as possible. Streamlining the triage system will not only increase the numbers of patients treated with thrombolytic therapy, it will ultimately reduce mortality and morbidity rates from acute myocardial infarction by limiting loss of heart muscle. Reducing the time to treatment, however, is a daunting task given that both patient and hospital delays contribute to the underutilization or inefficient use of thrombolytic therapy. In particular, patient delays can be difficult to attenuate, given that human behavior is complex and that designing interventions to change behavior is not only challenging but expensive. Results from the MITI registry show that the emergency medical system is the linchpin of an efficient triage system in that it is associated with reduced patient delays as well as reduced treatment delays. Clearly, patients with chest pain need to be aware of the need to take prompt action by calling 911. On the other hand, decisions to use these systems to acquire electrocardiograms or deliver thrombolytic treatment will be faced by increasing numbers of administrators and policy makers in the years to come. Without adequate community support to maintain and improve these systems, the full benefits of thrombolytic therapy cannot be attained.

Aged↗
PubMed1995

Outcomes in African-American women with suspected acute myocardial infarction: the Myocardial Infarction Triage and Intervention Project.

Increasing attention has been given to the investigation of cardiovascular disease in women, although African-American women have received little attention. This study compares characteristics and outcomes in women admitted to coronary care units for suspected acute myocardial infarction (MI). Between January 1988 and December 1991, a total of 554 (5%) African-American and 9738 (95%) white women with suspected acute MI were admitted to coronary care units in metropolitan Seattle, Washington. Relevant demographic socioeconomic, clinical, and outcome data were abstracted from the medical record and entered in the Myocardial Infarction Triage and Intervention registry. African-American women were younger, more often single and unemployed, and were less likely to have health insurance than their white counterparts. In addition, a higher proportion of African-American women reported a history of hypertension and diabetes mellitus. After adjustment for age, African-American women were equally as likely to develop acute MI and were more likely to die in the hospital. In addition, a higher proportion of African-American women were readmitted to coronary care units for suspected MI. Compared with their white counterparts, African-American women with suspected acute MI were considerably worse off from both socioeconomic and clinical standpoints, and their relative disadvantage was apparent in poor outcomes.

Black or African American↗