Differential Use of Coronary Revascularization and Hospital Mortality Following Acute Myocardial Infarction

Abstract

Nonclinical and clinical factors appear to account for blacks being least likely to have been revascularized. Despite these differences in revascularization rates, survival was similar for blacks and whites, whereas Hispanics were more likely to survive than whites.

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

“…3 Furthermore, among patients who were not revascularized, blacks were more likely to survive and be discharged than whites. 3 However, nonwhite patients in the TACTICS-TIMI-18 trial had less procedural success with PCI than white patients, and had a significantly higher risk of death, recurrent MI, or rehospitalization (and worse prognosis) after adjustment for patients' baseline medical characteristics. 11 One month postadmission for ACS, blacks at their follow-up reported significantly more symptoms and more clinic visits than whites.…”

“…13 In the analysis of 12 555 AMI patients in New York City, Hispanics were more likely to survive than whites, and among patients who were not revascularized, Hispanics were more likely to survive and be discharged than whites. 3 Having preexisting complications may worsen outcomes. In 1415 patients hospitalized for AMI in 2007 in San Juan, Puerto Rico, in-hospital mortality increased with age.…”

“…19 Overall, Hispanic patients presenting with ACS or MI are younger than white patients and are more likely to be uninsured. 3,7,19 -21 In a study of over 2 million AMI hospitalizations, Hispanic AMI patients were found to be younger than white AMI patients. 7 Among patients presenting with non-ST-segment elevation (NSTE) ACS from the National Registry of Acute Ischemic Coronary Syndromes (RENASICA) and Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) registries, Mexicans were younger than other Hispanics and non-Hispanic white patients.…”

“…Longer than whites More likely than whites More likely than whites Door-to-drug times 12 Prescribed aspirin 5 Survive and be discharged (when not treated with revascularization) 3 Door-to-balloon times 12 Rehospitalization (nonwhites) 11 More likely than whites Less likely than whites Recurrent AMI (nonwhites) 11 Slower transfer to revascularization hospital 14 Diagnostic cardiac catheterization 5 Recurrent AMI (5 years post-PCI) 32 Less likely than whites Catheterization 31,33 Rehospitalized for AMI (<1 year post-AMI) 18 Door-to-balloon times <90 minutes 13 Non-protocol mandated angiography (nonwhites) 11 Death (nonwhites) 11 Transfer to hospital with revascularization services 15 Use of lidocaine 6 Death following CABG (nonwhites) 28 PCI 5,7 Mortality (>30 days post-AMI) 15 PCI or CABG within 3 months of AMI 17 Mortality (5 years post-PCI) 32 Revascularization (admitted to nonrevascularization hospital) 15 Rehospitalization or death within 1 year post-CHD hospitalization 30 Revascularization 3,16,34 Adverse cardiac outcomes (1-year post revascularization) 35 6 Receive stent if undergoing PCI (nonwhites) 11 Less likely than whites Stress test 33 Procedural success with PCI (nonwhites) 11 Echocardiogram 33 Mortality <30 days post-AMI 15 Drug-eluting stents 4 Prescribed prasugrel 4 Prescribed clopidogrel 5 Prescribed GP IIb/IIIa inhibit...…”

Early and Late Unplanned Rehospitalizations for Survivors of Critical Illness

“…SPARCS is a comprehensive data reporting system that collects patient-level data, including patient characteristics, diagnoses and treatments, services, and charges for every hospital discharge in New York (NY) State. These data have been used extensively, both on their own and as part of the Nationwide Inpatient Sample, for research purposes (13)(14)(15). Within the database, each patient has a unique encrypted identifier, allowing for linkage of hospitalizations over time.…”