Race and Sex Differences in Management and Outcomes of Patients After ST‐Elevation and Non–ST‐Elevation Myocardial Infarct: Results From the NCDR

Abstract

BackgroundRace and sex have been shown to affect management of myocardial infarction (MI); however, it is unclear if such disparities exist in contemporary care of ST‐segment elevation myocardial infarction (STEMI) and non‐ST‐segment elevation myocardial infarction (NSTEMI).HypothesisDisparities in care will be less prevalent in more heavily protocol‐driven management of STEMI than the less algorithmic care of NSTEMI.MethodsData were collected from the ACTION Registry‐GWTG database to assess care differences related to race and sex of patients presenting with NSTEMI or STEMI. For key treatments and outcomes, adjustments were made including patient demographics, baseline comorbidities, and markers of socioeconomic status.ResultsKey demographic variables demonstrate significant differences in baseline comorbidities; black patients had higher incidences of hypertension and diabetes, and women more frequently had diabetes. With few exceptions, rates of acute and discharge medical therapy were similar by race in any sex category in both STEMI and NSTEMI populations. Rates of catheterization were similar by race for STEMI but not for NSTEMI, where both black men and women had lower rates of invasive therapy. Rates of revascularization were significantly lower for black patients in both the STEMI and NSTEMI groups regardless of sex. Rates of adverse events differed by sex, with disparities for death and major bleeding; after adjustment, rates were similar by race within sex comparisons.ConclusionsIn this contemporary cohort, although there are differences by race in presentation and management of MI, heavily protocol‐driven processes seem to show fewer racial disparities.

Gender differences in the decrease of in-hospital mortality in patients with acute myocardial infarction during the last 20 years in Switzerland

“… 36 This is in contrast to the findings of the ‘Acute Coronary Treatment and Intervention Outcomes Network Registry—Get with the Guidelines’ study of 75 370 patients with STEMI and NSTEMI enrolled from July 2008 to March 2011 where acute and discharge medical therapies were similar by race in any gender category. 37 In patients with NSTEMI, gender-based differences in adverse outcomes persisted even with an increased rate of early invasive therapy. 38 As the strategy of an early invasive approach for women with NSTEMI was considered controversial in the 2000s, we decided against analysing this particular point.…”

Racial Disparities in Patient Characteristics and Survival After Acute Myocardial Infarction

“…6 Disparities in some cardiovascular process measures, and even outcomes, have improved, 9 with strong protocol-driven processes of care appearing to reduce racial disparities in care and outcomes. 10 Despite the publication of these strategies, inequalities in morbidity and mortality rates between black patients and white patients still persist following AMI. 10,11 …”

“…10 Despite the publication of these strategies, inequalities in morbidity and mortality rates between black patients and white patients still persist following AMI. 10,11 …”

Recent patterns of vagal nerve stimulator use in the United States: Is there a racial disparity?

“…7 Blacks have been previously demonstrated to receive different treatments for the same condition for many medical conditions, including cancer, Parkinson disease, pain, heart disease, and epilepsy. [8][9][10][11][12] Racial and ethnic inequalities in access to neurological care including epilepsy surgeries such as temporal lobe epilepsy surgery have been demonstrated to occur independently of demographics, insurance, and health status. 13 We evaluated the trends and racial disparities in the use of a VNS among patients with refractory epilepsy between 2006 and 2014 using the largest database of hospitalized patients, which is nationally representative.…”