American Heart Journal
Volume 152, Issue 1 , Pages 110-117, July 2006

Clinical characteristics, process of care, and outcomes of Hispanic patients presenting with non–ST-segment elevation acute coronary syndromes: Results from Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE)

  • Mauricio G. Cohen, MD

      Affiliations

    • Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    • Corresponding Author InformationReprint requests: Mauricio G. Cohen, MD, Division of Cardiology, University of North Carolina, 130 Mason Farm Road, CB #7075, Bioinformatics Building, Suite 4128, Chapel Hill, NC 27599-7075.
    • ,
  • Matthew T. Roe, MD, MHS

      Affiliations

    • Duke Clinical Research Institute, Durham, NC
    • ,
  • Jyotsna Mulgund, MS

      Affiliations

    • Duke Clinical Research Institute, Durham, NC
    • ,
  • Eric D. Peterson, MD, MPH

      Affiliations

    • Duke Clinical Research Institute, Durham, NC
    • ,
  • Ali F. Sonel, MD

      Affiliations

    • Pittsburgh VA Health System and University of Pittsburgh, Pittsburgh, PA
    • ,
  • Venu Menon, MD

      Affiliations

    • Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    • ,
  • Sidney C. Smith Jr, MD

      Affiliations

    • Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    • ,
  • Jorge F. Saucedo, MD

      Affiliations

    • University of Oklahoma Health Sciences Center, Oklahoma City, OK
    • ,
  • Barbara L. Lytle, MS

      Affiliations

    • Duke Clinical Research Institute, Durham, NC
    • ,
  • Charles V. Pollack Jr, MD, MA

      Affiliations

    • Pennsylvania Hospital, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • Luis Garza, MD

      Affiliations

    • University of Arkansas for Medical Sciences, Little Rock, AR
    • ,
  • W. Brian Gibler, MD

      Affiliations

    • Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
    • ,
  • E. Magnus Ohman, MD

      Affiliations

    • Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC

Received 29 June 2005; accepted 7 September 2005.

Background

Data regarding the management of non–ST-segment elevation acute coronary syndromes (NSTE ACS) in Hispanic patients, the largest and fastest-growing minority in the United States, are scarce.

Methods

We sought to describe the clinical characteristics, process of care, and outcomes of Hispanics presenting with NSTE ACS at US hospitals. We compared baseline characteristics, resource use, and inhospital mortality among 3936 Hispanics and 90280 non-Hispanic whites with NSTE ACS from the CRUSADE Quality Improvement Initiative.

Results

The regional distribution of Hispanics in CRUSADE paralleled that in the US Census. Hispanics were younger (65 vs 70 years, P < .0001) and had less hyperlipidemia (45.4% vs 49.0%, P < .0001) but were more likely to be hypertensive (72.2% vs 67.9%, P < .0001) and diabetic (46.5% vs 30.9%, P < .0001). Hispanics were also more likely to be uninsured (12.5% vs 5.1%, P < .001). During hospitalization, Hispanics were more often managed conservatively, undergoing stress tests more frequently (13.0% vs 10.1%, P < .0001), with less use of cardiac catheterization within 48 hours (48.7% vs 55.5%, P < .0001) or percutaneous coronary intervention (39.6% vs 46.4%, P < .0001) at any time. Hispanics received similar discharge treatments but were less frequently referred for cardiac rehabilitation (38.5% vs 49.2%, P < .0001). Adjusted inhospital mortality was similar in both groups (odds ratio 0.87, 95% CI 0.72-1.05).

Conclusions

Although hispanics have a different risk factor profile and are treated less aggressively during hospitalization when they present with NSTE ACS, these treatment differences do not appear to affect inhospital outcomes. Further research is warranted to explore the long-term consequences of these findings.

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 CRUSADE is a National Quality Improvement Initiative of the Duke Clinical Research Institute. CRUSADE is funded by Millennium Pharmaceuticals, Inc, Cambridge, Mass, and Schering Corporation, Kenilworth, NJ. Bristol-Myers Squibb (Plainsboro, NJ)/Sanofi Pharmaceuticals (New York, NY) Partnership provides additional support.

 Guest editor of this manuscript is Morton J. Kern, MD.

PII: S0002-8703(05)00848-3

doi:10.1016/j.ahj.2005.09.003

American Heart Journal
Volume 152, Issue 1 , Pages 110-117, July 2006

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