January 1, 1991Circulation
Racial differences in responses to thrombolytic therapy with recombinant tissue-type plasminogen activator. Increased fibrin(ogen)olysis in blacks. The Thrombolysis and Angioplasty in Myocardial Infarction Study Group.
Key result
Black patients receiving rt-PA for MI show no significant difference in 90-minute patency versus White patients.
- P=0.051
- n=376
Why the study?
Are there racial differences in responses to thrombolytic therapy with rt-PA between black and white patients with myocardial infarction?
Population
376 patients with myocardial infarction from the Thrombolysis and Angioplasty in Myocardial Infarction study
Comparison
Recombinant tissue-type plasminogen activator… vs Comparison between black and white patients…
Design
Cohort
Follow-up
until hospital discharge
Authors
Discussion
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Implication
Observed racial differences in rt-PA response should not change practice; leaves open targeted research on fibrinolytic dosing by race.
Key Points
- To determine racial differences in responses to thrombolytic therapy with rt-PA in black and white patients.
- Analyzed data from the Thrombolysis and Angioplasty in Myocardial Infarction phase 1 study.
- Compared outcomes between 352 white patients and 24 black patients.
- Assessed patency rates, fibrinogen levels, and clinical outcomes.
- Patency rate at 90 minutes: 91% in blacks vs. 72% in whites (p=0.051).
- Blacks had lower nadir fibrinogen levels (0.57 g/l vs. 1.3 g/l, p<0.0001) and greater delta fibrinogen (2.7 g/l vs. 1.7 g/l, p<0.0001).
- Blacks received more transfusions (58.8% vs. 19.5%, p=0.001), despite fewer angioplasty procedures (25% vs. 46.3%, p=0.047).
Study Design
Type
Cohort (n=376)
Multicenter
Yes
Structured PICO
Are there racial differences in responses to thrombolytic therapy with rt-PA between black and white patients with myocardial infarction?
P
Population
376 patients (352 white and 24 black) with myocardial infarction treated with recombinant tissue-type plasminogen activator in the TAMI phase 1 study.
E
Exposure
Recombinant tissue-type plasminogen activator (rt-PA) therapy
C
Comparator
Comparison between black and white patients receiving the same rt-PA therapy
O
Outcome
Patency rate of the infarct-related artery at 90 minutes and fibrinogen levelssurrogate
Main Result
Absolute Event Rate: 91% vs 72%
p-value: p=0.051
Black patients treated with rt-PA for myocardial infarction exhibit increased fibrin(ogen)olysis and higher transfusion requirements compared to white patients, despite similar survival rates.
Cite This Study
Sane et al. (1991) conducted a cohort in Myocardial Infarction (n=376). Black race vs. White race was evaluated on Patency rate of the infarct-related artery at 90 minutes (p=0.051). In patients receiving rt-PA for myocardial infarction, black patients had a 90-minute infarct-related artery patency rate of 91% compared to 72% in white patients (p=0.051).