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1.
Clin Cardiol ; 36(12): 749-56, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24085713

RESUMO

BACKGROUND: Prior studies have described racial/ethnic disparities in door-to-balloon (DTB) time for patients undergoing primary percutaneous coronary intervention (PCI). We sought to compare DTB time between different racial/ethnic groups undergoing primary PCI for ST-elevation myocardial infarction in Get With the Guidelines (GWTG). HYPOTHESIS: There may be differences in D2B time associated with race/ethnicity. METHODS: We identified 7445 white (n = 6365), African American (n = 568), and Hispanic (n = 512) patients undergoing primary PCI. RESULTS: There were no differences in the median DTB time between white (74 minutes; intraquartile range [IQR], 54-99), African American (77 minutes; IQR, 57-100), and Hispanic (75 minutes; IQR, 56-100) (P = 0.13) patients. There were no crude differences in DTB time ≤90 minutes; however, after adjusting for confounders, African American race was associated with lower odds of DTB time ≤90 minutes (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.70-0.99; P = 0.04). This association was seen in African American males (OR: 0.66; 95% CI: 0.55-0.80) but not African American females (OR: 1.27; 95% CI: 0.96-1.68). Overall, Hispanic ethnicity was not associated with a difference in DTB time ≤90 minutes (OR: 0.98; 95% CI: 0.77-1.25; P = 0.88); although Hispanic males did have a slightly longer median DTB time compared with whites. During the study, the proportion of patients with DTB times ≤90 minutes increased for all groups, and mortality was similar between groups (white 3.8%, African American 3.0%, Hispanic 4.1%, P = 0.62). CONCLUSIONS: In GWTG-Coronary Artery Disease, small differences in DTB times persist among different races/ethnicities. However, the proportion achieving DTB times ≤90 minutes has increased substantially for all patients over time, and there was no association between race/ethnicity and in-hospital mortality.


Assuntos
Negro ou Afro-Americano , Disparidades em Assistência à Saúde/etnologia , Hispânico ou Latino , Infarto do Miocárdio/etnologia , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea , Tempo para o Tratamento , População Branca , Idoso , Distribuição de Qui-Quadrado , Feminino , Fidelidade a Diretrizes , Acessibilidade aos Serviços de Saúde , Mortalidade Hospitalar/etnologia , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Razão de Chances , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Intervenção Coronária Percutânea/normas , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Tempo para o Tratamento/normas , Resultado do Tratamento , Estados Unidos/epidemiologia
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