Acute Coronary Syndromes

In ACS, African American patients are more likely to be younger and to have hypertension, diabetes, heart failure, and renal insufficiency. They are also less likely to have insurance coverage or specialist care.96,97 Recently, the investigator of CRUSADE, a large NSTEMI registry, found that African American patients were likely to receive more older ACS treatments, such as aspirin, P-blockers, and ACE inhibitors, but were significantly less likely to receive newer ACS therapies such as GP IIb/IIIa inhibitors, clopido-grel, and statin therapy.96 Also, African Americans were less likely to receive cardiac catheterization, revascularization, or smoking cessation counseling. The rates of in-hospital death and postadmission MI were similar between African American and Caucasian patients in CRUSADE (adjusted OR = 0.92; 95% CI: 0.81 to 1.05).96 However, in TACTICS-TIMI 18, African American patients were had an increased risk of death, MI, or rehospitalization (adjusted OR = 1.34; 95%CI: 1.14 to 3.48).97 There may be several factors explaining the decreased rates of catheteriza-tion and revascularization in African Americans. In addition to patient preference and physician recommendations, African American patients with ACS are more likely to be treated in low-volume hospitals.98,99 Although there are some data regarding race-specific differential responses to antihypertensive medications, to our knowledge there are no race-specific data on adjunctive PCI pharmacotherapy.

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