Racial Difference in Symptom Onset to Door Time in ST Elevation Myocardial Infarction
Oluwaseyi Bolorunduro1, Blake Smith1, Mason Chumpia1
1Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Insights
Black patients experience poorer ST-elevation myocardial infarction outcomes. They present later to the ER, but door-to-reperfusion times are similar to white patients, suggesting delayed presentation may contribute to disparities.
Area of Science:
- Cardiology
- Health Disparities
- Public Health
Background:
- Poorer outcomes observed in Black patients post ST-elevation myocardial infarction (STEMI) compared to white patients.
- Comparable door-to-reperfusion times between racial groups despite outcome disparities.
- Hypothesis: Delays in hospital presentation may contribute to observed outcome differences.
Purpose of the Study:
- To investigate potential delays in hospital presentation among Black patients with STEMI.
- To compare symptom-onset-to-door time (SODT) and door-to-balloon time (D2BT) between Black and white patients.
- To identify factors contributing to disparities in STEMI presentation and care.
Main Methods:
- Retrospective analysis of 1144 STEMI patients (2008-2013).
- Comparison of D2BT and SODT by race, controlling for insurance, age, sex, and comorbidities.
- Bivariate and stratified analyses to evaluate racial effects on presentation and treatment times.
Main Results:
- No significant difference in D2BT by race (P=0.86).
- Black patients had significantly longer SODT (180 min vs. 120 min, P<0.01).
- Black patients were more likely to be uninsured and presented later (OR 1.6, P<0.01) after controlling for covariates.
Conclusions:
- Black patients present later to the emergency room following STEMI.
- No racial difference in door-to-balloon time was observed.
- Delayed presentation may be a key factor contributing to worse STEMI outcomes in Black patients.
Background:
There are poorer outcomes following ST elevation myocardial infarction in blacks compared to white patients despite comparable door-to-reperfusion time. We hypothesized that delays to hospital presentation may be contributory.
Methods And Results:
We conducted a retrospective analysis of the 1144 patients admitted for STEMI in our institution from 2008 to 2013. The door-to-balloon time (D2BT) and symptom-onset-to-door time (SODT) were compared by race. Bivariate analysis was done comparing the median D2BT and SODT. Stratified analyses were done to evaluate the effect of race on D2BT and SODT, accounting for insurance status, age, sex and comorbidities. The mean age was 59±13 years; 56% of this population was black and 41% was white. Males accounted for 66% of this population. The median D2BT was 60 minutes (interquartile range [IQR] 42-82), and median SODT was 120 minutes (IQR 60-720). There was no significant difference in D2BT by race (P=0.86). Black patients presented to the emergency room (ER) later than whites (SODT=180 [IQR 60-1400] vs 120 [IQR 60-560] minutes, P<0.01) and were more likely to be uninsured (P<0.01). After controlling for comorbidities, insurance, and socioeconomic status, blacks were 60% more likely to present late after a STEMI (OR 1.6, P<0.01). A subset analysis excluding transferred patients showed similar results.
Conclusions:
Black patients present later to the ER after STEMI with no difference in D2BT compared to whites. This difference in time to presentation may be one of the factors accounting for poor outcomes in this population.
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