Post-MI Death Risk Differs by Race

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Among CKD patients, African Americans are more likely to die than Caucasians after a heart attack.

PHILADELPHIA—African-Americans CKD patients have significantly worse survival following an acute MI than their Caucasian counterparts, researchers have found.

In a study of 1,847 subjects who had experienced an acute MI—1,333 Caucasians and 514 African Americans—followed up for up to 3.5 years, researchers found that, among patients with CKD, African Americans were at 43% higher risk of death than Caucasians after adjusting for numerous potential confounders. Investigators defined CKD as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2.

The researchers, led by Sundar Sankaran, MD, a nephrology fellow at Kansas University Medical Center in Kansas City, examined mortality risk according to various strata of eGFR. For both races, the risk increased with decreasing GFR, but the magnitude of these increases was more pronounced in African Americans at each stratum of eGFR.

African Americans with an eGFR less than 30, 30-59, and 60 mL/min/1.73 m2 or higher had a 3.7, 2.5, and 1.7 times increased mortality risk, respectively, compared with Caucasians without CKD (eGFR of 60 or higher), Dr. Sankara's group reported here at the American Society of Nephrology's Renal Week meeting. Among Caucasians, those with an eGFR less than 30 and 30-59 had an 89% and 65% greater mortality risk, respectively, compared with subjects who had an eGFR of 60 or higher. The researchers observe no difference in mortality risk among subjects without CKD.

The reasons for the racial disparity is unclear, but genetic differences and access to care could be among the contributing factors, Dr. Sankaran said, noting that African Americans who suffer an acute MI are known to present later for treatment.
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