Skip to main content
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 1997 Oct;89(10):665–671.

Causes of chest pain and symptoms suggestive of acute cardiac ischemia in African-American patients presenting to the emergency department: a multicenter study.

C Maynard 1, J R Beshansky 1, J L Griffith 1, H P Selker 1
PMCID: PMC2608251  PMID: 9347680

Abstract

This study examines whether race is a significant determinant of the diagnoses of acute myocardial infarction or angina pectoris in patients with symptoms suggestive of acute cardiac ischemia. The study population was comprised of 3401 (34%) African-American and 6600 (66%) white patients who presented to emergency departments with symptoms suggestive of acute cardiac ischemia. The main outcome measure was a diagnosis of acute myocardial infarction or angina pectoris. African Americans were younger, predominantly female, and more often had hypertension, diabetes mellitus, or smoked. The diagnosis of acute myocardial infarction was confirmed in 6% of African-American and 12% of white men, and in 4% of African-American and 8% of white women. After adjusting for age, gender, medical history, signs and symptoms, and hospital, African Americans were half as likely to develop acute myocardial infarction and were 60% as likely to have acute cardiac ischemia. Despite having less acute cardiac ischemia, African Americans in this study had high risk levels for coronary artery disease.

Full text

PDF
669

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Becker L. B., Han B. H., Meyer P. M., Wright F. A., Rhodes K. V., Smith D. W., Barrett J. Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project. N Engl J Med. 1993 Aug 26;329(9):600–606. doi: 10.1056/NEJM199308263290902. [DOI] [PubMed] [Google Scholar]
  2. Campeau L. Letter: Grading of angina pectoris. Circulation. 1976 Sep;54(3):522–523. [PubMed] [Google Scholar]
  3. Clark L. T., Bellam S. V., Shah A. H., Feldman J. G. Analysis of prehospital delay among inner-city patients with symptoms of myocardial infarction: implications for therapeutic intervention. J Natl Med Assoc. 1992 Nov;84(11):931–937. [PMC free article] [PubMed] [Google Scholar]
  4. Cooper R. S., Ford E. Comparability of risk factors for coronary heart disease among blacks and whites in the NHANES-I Epidemiologic Follow-up Study. Ann Epidemiol. 1992 Sep;2(5):637–645. doi: 10.1016/1047-2797(92)90008-e. [DOI] [PubMed] [Google Scholar]
  5. Cooper R. S., Simmons B., Castaner A., Prasad R., Franklin C., Ferlinz J. Survival rates and prehospital delay during myocardial infarction among black persons. Am J Cardiol. 1986 Feb 1;57(4):208–211. doi: 10.1016/0002-9149(86)90892-1. [DOI] [PubMed] [Google Scholar]
  6. Cowie M. R., Fahrenbruch C. E., Cobb L. A., Hallstrom A. P. Out-of-hospital cardiac arrest: racial differences in outcome in Seattle. Am J Public Health. 1993 Jul;83(7):955–959. doi: 10.2105/ajph.83.7.955. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ell K., Haywood L. J., Sobel E., deGuzman M., Blumfield D., Ning J. P. Acute chest pain in African Americans: factors in the delay in seeking emergency care. Am J Public Health. 1994 Jun;84(6):965–970. doi: 10.2105/ajph.84.6.965. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Jayes R. L., Jr, Beshansky J. R., D'Agostino R. B., Selker H. P. Do patients' coronary risk factor reports predict acute cardiac ischemia in the emergency department? A multicenter study. J Clin Epidemiol. 1992 Jun;45(6):621–626. doi: 10.1016/0895-4356(92)90134-9. [DOI] [PubMed] [Google Scholar]
  9. Johnson P. A., Lee T. H., Cook E. F., Rouan G. W., Goldman L. Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med. 1993 Apr 15;118(8):593–601. doi: 10.7326/0003-4819-118-8-199304150-00004. [DOI] [PubMed] [Google Scholar]
  10. Killip T., 3rd, Kimball J. T. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol. 1967 Oct;20(4):457–464. doi: 10.1016/0002-9149(67)90023-9. [DOI] [PubMed] [Google Scholar]
  11. Lenfant C. Report of the NHLBI Working Group on Research in Coronary Heart Disease in Blacks. Circulation. 1994 Oct;90(4):1613–1623. doi: 10.1161/01.cir.90.4.1613. [DOI] [PubMed] [Google Scholar]
  12. Liao Y., Cooper R. S., Ghali J. K., Szocka A. Survival rates with coronary artery disease for black women compared with black men. JAMA. 1992 Oct 14;268(14):1867–1871. [PubMed] [Google Scholar]
  13. Maynard C., Every N. R., Litwin P. E., Martin J. S., Weaver W. D. Outcomes in African-American women with suspected acute myocardial infarction: the Myocardial Infarction Triage and Intervention Project. J Natl Med Assoc. 1995 May;87(5):339–344. [PMC free article] [PubMed] [Google Scholar]
  14. Maynard C., Fisher L. D., Passamani E. R., Pullum T. Blacks in the Coronary Artery Surgery Study: risk factors and coronary artery disease. Circulation. 1986 Jul;74(1):64–71. doi: 10.1161/01.cir.74.1.64. [DOI] [PubMed] [Google Scholar]
  15. Maynard C., Litwin P. E., Martin J. S., Cerqueira M., Kudenchuk P. J., Ho M. T., Kennedy J. W., Cobb L. A., Schaeffer S. M., Hallstrom A. P. Characteristics of black patients admitted to coronary care units in metropolitan Seattle: results from the Myocardial Infarction Triage and Intervention Registry (MITI). Am J Cardiol. 1991 Jan 1;67(1):18–23. doi: 10.1016/0002-9149(91)90092-y. [DOI] [PubMed] [Google Scholar]
  16. Raczynski J. M., Taylor H., Cutter G., Hardin M., Rappaport N., Oberman A. Diagnoses, symptoms, and attribution of symptoms among black and white inpatients admitted for coronary heart disease. Am J Public Health. 1994 Jun;84(6):951–956. doi: 10.2105/ajph.84.6.951. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Selker H. P., Griffith J. L., D'Agostino R. B. A tool for judging coronary care unit admission appropriateness, valid for both real-time and retrospective use. A time-insensitive predictive instrument (TIPI) for acute cardiac ischemia: a multicenter study. Med Care. 1991 Jul;29(7):610–627. doi: 10.1097/00005650-199107000-00002. [DOI] [PubMed] [Google Scholar]
  18. Simmons B. E., Castaner A., Campo A., Ferlinz J., Mar M., Cooper R. Coronary artery disease in blacks of lower socioeconomic status: angiographic findings from the Cook County Hospital Heart Disease Registry. Am Heart J. 1988 Jul;116(1 Pt 1):90–97. doi: 10.1016/0002-8703(88)90254-2. [DOI] [PubMed] [Google Scholar]
  19. Strogatz D. S. Use of medical care for chest pain: differences between blacks and whites. Am J Public Health. 1990 Mar;80(3):290–294. doi: 10.2105/ajph.80.3.290. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES