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Published on: January 18, 2018
Disparities in Revascularization After ST Elevation Myocardial Infarction (STEMI) Before and After the 2002 IOM
Oluwaseyi B Bolorunduro1, Adekunle V Kiladejo2, Islamiyat Babs Animashaun3
1Division of Cardiology, University of Tennessee Health Science Center, 956 Court Avenue, Ste. A318D, Memphis, TN 38163, USA.
Insights
Racial disparities in Percutaneous Coronary Intervention (PCI) after ST-elevated Myocardial Infarction (STEMI) persist. African Americans and Hispanics remain less likely to receive PCI compared to Caucasians, despite increased awareness.
Area of Science:
- Cardiology
- Health Services Research
- Health Equity
Background:
- The 2002 Institute of Medicine report highlighted disparities in revascularization for African Americans post-STEMI.
- It recommended increased awareness to reduce these inequities.
- This study investigates if awareness has led to reduced racial disparities in PCI.
Purpose of the Study:
- To examine nationwide trends in racial disparities for Percutaneous Coronary Intervention (PCI) following ST-elevated Myocardial Infarction (STEMI).
- To determine if awareness of disparities has reduced PCI utilization differences among ethnic groups.
Main Methods:
- Retrospective analysis of the Agency of Healthcare Research and Quality's National Inpatient Sample (NIS) from 1998-2007.
- Identified patients with STEMI and compared rates of primary PCI by ethnicity.
- Used multivariable Poisson regression, controlling for demographic and hospital factors.
Main Results:
- Over 2 million acute myocardial infarction patients were analyzed; 938,176 had STEMI.
- Primary PCI rates for STEMI were lower for African Americans (23.3%) and Hispanics (28.3%) compared to Caucasians (29.1%).
- Multivariate analysis showed African Americans and Hispanics were significantly less likely to receive PCI than Caucasians (IRR 0.74 and 0.84, respectively).
Conclusions:
- Ethnic disparities in primary PCI after STEMI persist.
- These inequities remain despite the 2002 IOM report and increased awareness.
- Further interventions are needed to address racial and ethnic gaps in STEMI treatment.
Objectives:
To examine nationwide trends for racial disparities in Percutaneous Coronary Intervention after ST elevated Myocardial Infarction (STEMI).
Background:
The Institute of Medicine (IOM) report published in 2002 showed that African Americans were less likely to receive coronary revascularization such as CABG and stents even after controlling for socioeconomics. It recommended increased awareness of these disparities among health professionals to reduce this. We hypothesized that increased awareness of disparities since this report would have translated to reduction in racial disparities in percutaneous coronary intervention.
Methods:
A retrospective analysis was conducted using data from the Agency of Healthcare Research and Quality's (AHRQ) National Inpatient Sample (NIS) 1998-2007. All patients with STEMI during this period were identified. The proportion that received Percutaneous Coronary Intervention (PCI) during the incident admission was compared by different ethnicities over the time period. Multivariable regression for each year was conducted using Poisson regression with robust variances. The analysis controlled for gender, insurance status, co-morbidities, hospital bed size, location and teaching status.
Results:
Based on the database, about 2.04 million patients were managed for acute Myocardial Infarction from 1998 to 2007, of these 938,176 had STEMI. The primary PCI rate after STEMI among Caucasians was 29.1%, African Americans-23.3% and Hispanics-28.3% [P < 0.001] On multivariate regression, compared to Caucasians, African Americans and Hispanics respectively were 26% (IRR = 0.74) and 16% (IRR = 0.84) less likely to receive PCI (both with P < 0.001) during the entire study period.
Conclusion:
Ethnic disparities in primary PCI after STEMI persist despite the 2002 IOM report.
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