Race and Prognosis After Myocardial Infarction Results of the Thrombolysis in Myocardial Infarction ( TIMI ) Phase II Trial Herman

Background. To better understand the role of race/ethnicity in survival after acute myocardial infarction, we compared clinical and laboratory data, response to thrombolytic therapy, and clinical outcome in 2885 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 ofwomen for whites, 17.6; blacks, 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 whites, 11.9; blacks, 22.4; Hispanics, 19.7; P<.001). Changes in hemostatic factors 5 hours after infusion of recombinant tissue plasminogen activator (rt-PA) revealed a more profound fall in fibrinogen levels in black patients compared with the response seen in Hispanic or white patients (mean change in fibrinogen ±SD, mg/dL: 151.3± 107.4, 112.2 ±97.0, 109.4±98.6; P<.001, respectively) without more frequent infarct-related artery patency or hemorrhagic complications. Mortality was similar in the white, black, and Hispanic patients through the first year after adjustment for baseline variables. Conclusions. TIMI 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