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ARTICLE | April 10, 1996

Influence of Race, Sex, and Age on Management of Unstable Angina and Non—Q-Wave Myocardial Infarction: Title and subTitle BreakThe TIMI III Registry FREE

Peter H. Stone, MD; Bruce Thompson, PhD; H. Vernon Anderson, MD; Marvin W. Kronenberg, MD; Robert S. Gibson, MD; William J. Rogers, MD; Daniel J. Diver, MD; Pierre Théroux, MD; J. W. Warnica, MD; James B. Nasmith, MD; Catherine Kells, MD; Neal, MD; Carolyn H. McCabe; Mark Schactman, MS; Genell L. Knatterud, PhD; Eugene Braunwald, MD; Eugene Braunwald, MD; Peter H. Stone, MD; Christopher P. Cannon, MD; Carolyn H. McCabe; Genell L. Knatterud, PhD; Bruce Thompson, PhD; Joyce Depkin; Martha Canner, MS; Patricia Wilkins; Rosemary Giro; Mark Schactman, MS; Christopher P. Cannon, MD; Neal Kleiman, MD; Marilyn J. Francis, RN; Kay Yang, RN; Peter H. Stone, MD; Christopher P. Cannon, MD; Nancy Cummings, RN; Daniel J. Diver, MD; Donald S. Balm, MD; Joseph Carozza, MD; Susan Marble, MS, RN; Ann Slater, RN; James B. Nasmith, MD; Donald Pallsaltis, MD; Ginette Gaudette, RN; Thomas L. Shook, MD; Carolyn Gray, RN; Pierre Théroux, MD; Pierre De Guise, MD; Johanne Levesque, RN; Marie-Andrée Séguin; Faryala Shabani, MD; Peter Mahrer, MD; Joni Noceda, RN; Judy Fletcher, RN; Bernard Chaitman, MD; Frank Aquirre, MD; Leslie Miller, MD; Morton Kern, MD; Robert Weins, MD; Arthur Labovitz, MD; Lawrence Lewis, MD; Glenda Haas, RN; Judith Hochman, MD; Anthony Pepe, MD; Mary McAnulty, RN; Deborah Tormey, RN; William J. Rogers, MD; William A. Baxley, MD; Larry S. Dean, MD; Vera A. Bittner, MD; Louis J. Dell'Italia, MD; Jerri Moody, RN; Cynthia Weeks; J. Wayne Warnica, MD; E. R. Smith, MD; D. G. Wyse, MD; M. L. Knudtson, MD; Christine Hall, RN; Terry Churchill-Smith, RN; Ted Feldman, MD; Matthew J. Sorrentino, MD; Anne Pastoret, RN; Sharon Holloway, RN, MSN; Marcus Williams, MD; Gregory J. Dehmer, MD; David A. Tate, MD; Mary Jackson, RN, MSN; James T. Willerson, MD; H. V. Anderson, MD; Louise Jones, RN; Lynette Weigelt, RN; Marvin W. Kronenberg, MD; Michael J. Davis, MD; Robert W. Farrell, MD; M. Amir Ibrahim, MD; John F. Schmedtje, Jr, MD, MPH; Robert S. Gibson, MD; Eric R. Powers, MD; Sharon L. Sayre, BSN; Nancy M. Fauber, MSN; Catherine M. Kells, MD; David Johnstone, MD; Theresa Fawcett, RN; Vivian Nedelcu

[+] Author Affiliations

A complete list of the Thrombolysis in Myocardial Ischemia (TIMI) III Registry appears at the end of this article.

Corresponding author: Peter H. Stone, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.

Reprints: Genell L. Knatterud, PhD, TIMI III Registry Data Coordinating Center, Maryland Medical Research Institute, 600 Wyndhurst Ave, Baltimore, MD 21210.

JAMA. 1996;275(14):1104-1112. doi:10.1001/jama.1996.03530380046030

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ABSTRACT

ABSTRACT | REFERENCES

Objective. —To investigate the natural history and response to treatment of patients with unstable angina or non—Q-wave myocardial infarction (MI).

Design. —Inception cohort.

Setting. —Patients in general community, primary care, or referral hospitals.

Patients. —All patients with an episode of unstable exertional chest pain or chest pain at rest presumed to be ischemic in origin lasting 5 minutes or more but without persisting ST-segment elevation greater than 30 minutes or the development of Q-waves were identified and enumerated in 18 participating hospitals. A subset of enumerated patients was selected to be followed prospectively using specific sampling strategies that would provide adequate numbers of black, women, and elderly (aged ≥75 years) patients for comparison with their respective counterparts. Main Outcome Measures.—The primary analysis compared the incidence of death or Ml at 42 days after entry into the prospective study according to race, sex, and age. Other outcomes considered were recurrent ischemia and the combined outcomes of death, Ml, or recurrent ischemia by 42 days after entry.

Results. —A total of 8676 admissions with unstable angina or non—Q-wave Ml were enumerated and, of these, 3318 patients were selected for the prospective study. The direct adjusted mean age of the 3318 patients was 63.8 years. There were 943 blacks and 2375 nonblacks. Compared with nonblacks, blacks were less likely to be treated with intensive anti-ischemic therapy for their qualifying anginal episode and less likely to undergo invasive procedures (risk ratio [RR], 0.65; 95% confidence interval [CI], 0.58 to 0.72; P<.001). However, of those who underwent angiography (45% of blacks and 61% of nonblacks), blacks had less extensive and severe coronary stenoses than nonblacks. The incidence of death and MI was similar for blacks and nonblacks, but blacks had a lower incidence of recurrent ischemia. There were 1678 men and 1640 women. Women were less likely than men to receive intensive anti-ischemic therapy and less likely to undergo coronary angiography (RR, 0.71; 95% CI, 0.65 to 0.78; P<.001). Women had less severe and extensive coronary disease and were less likely to undergo revascularization, yet had a similar risk of experiencing an adverse cardiac event by 6 weeks. There were 2490 patients aged 75 years or less and 828 patients aged more than 75 years. Elderly patients received less aggressive anti-ischemic therapy and were less likely to undergo coronary angiography than their younger counterparts. Elderly patients had more severe and extensive coronary disease but fewer revascularization procedures than younger patients and experienced a much higher incidence of adverse cardiac events both in hospital and by 6 weeks.

Conclusions. —Among patients presenting with acute ischemic chest pain without persistent ST-segment elevation, blacks appeared to have less severe coronary disease, received revascularization less frequently, and had less recurrent ischemia compared with nonblacks. Women also were found to have less severe coronary disease and were treated less intensely than men, but experienced similar outcomes. Elderly patients had more severe coronary disease than younger patients on coronary angiography, but were more likely to be treated medically, and they experienced far more adverse outcomes. These data suggest that more aggressive strategies should be directed to those patients with the greatest likelihood of adverse outcomes.(JAMA. 1996;275:1104-1112)

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal