Racial Disparity in Clinical Outcomes Following Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction: Influence of Process of Care

Abstract

Previous studies have shown that compared with white patients, non-white patients with ST elevation myocardial infarction (STEMI) have worse clinical outcomes. Differences in co-morbidities, extent and severity of coronary artery disease, health insurance, and socioeconomic status have been identified as possible reasons for this disparity. However, an alternative explanation for such observed disparities in outcomes could be differences in process of care. For example, in most of these studies, non-white patients were less likely to receive reperfusion therapy, and if treated, were more likely to receive thrombolysis than to undergo primary percutaneous coronary intervention (PCI). We hypothesized that if all patients were treated similarly with primary PCI, there would be no difference in clinical outcomes. We analyzed the demographic, angiographic, in-hospital clinical outcomes, and long-term mortality rates of a racially diverse group of patients presenting to the same hospital with STEMI, all of whom were treated with primary PCI. Our data demonstrate that compared with white patients, non-white patients with STEMI who undergo primary PCI have similar in-hospital clinical outcomes and one-year mortality. This suggests that the previously observed differences in mortality rates may be, at least in part, attributable to differences in the process of care, and not solely to differences in patient factors or differential therapeutic effects.

Reliability of Cardiovascular Risk Calculators to Estimate Accurately the Risk of Cardiovascular Disease in Patients With Sarcoidosis

“…Thus, some of the pertinent data were not available and precluded certain analyses such as evaluation of risk assessment tools with CRP. Generalizability of the performance of the risk scores in this cohort to other populations may be limited as clinical manifestation of sarcoidosis and baseline risk of CVD vary among ethnic groups 27–30 and the population of Olmsted County is predominately of Northern European ancestry. It is possible that the calculators may perform even worse among Blacks with sarcoidosis as they tend to have a more severe disease and, thus, more inflammatory burden and exposure to glucocorticoid.…”

Outcomes and Resource Utilization in ST‐Elevation Myocardial Infarction in the United States: Evidence for Socioeconomic Disparities

“…It has been demonstrated that if all patients with STEMI were treated with an identical protocol for primary PCI, there would be no racial disparity in clinical outcomes. 32 Hence, although it is convenient to label patients by race, factors that relate to SES such as income, education, housing, and social awareness are probably more important in health‐related outcomes. Socioeconomic position has been speculated to be a greater impediment to optimal cardiovascular health rather than “biologically implausible surrogates of race and sex.” 33 …”

Characteristics of ST Elevation Myocardial Infarction Patients Who Do Not Undergo Percutaneous Coronary Intervention After Prehospital Cardiac Catheterization Laboratory Activation

“…(26) In addition, non-whites are less likely to receive reperfusion therapy or be transferred for PCI. (27)(28)(29) Many explanations have been suggested as to the cause of this disparity including worse CAD, abundant co-morbidities, worse socioeconomic status, and geographic location with impaired access to specialists.…”

“…(27,30) However, it is difficult to ascertain the predominant factors associated this disparity especially with a protocol that should treat all-comers equally. With the data available it is unclear if some of these patients that did not undergo PCI went on to get bypass grafting due to more advanced CAD or not.…”

“…(27,31) This result in particular would benefit from a larger prospective cohort analysis looking at MI management within the system to identify the leading causes of this disparity including any provider biases (unconscious or otherwise).…”