Disparities by Race and Ethnicity in Percutaneous Coronary Intervention
Charleen Hsuan1, Michelle P Lin2, Alexis Zebrowski3,4,5
1Department of Health Policy and Administration, Pennsylvania State University, University Park.
Insights
Racial and ethnic disparities in percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) persist throughout care. The largest disparity in PCI receipt occurred among transferred patients, but the greatest impact was seen in initial PCI-capable hospital presentations.
Area of Science:
- Cardiovascular Medicine
- Health Equity
- Health Services Research
Background:
- Patients with ST-segment elevation myocardial infarction (STEMI) from minority racial and ethnic groups are less likely to receive guideline-recommended percutaneous coronary intervention (PCI).
- Existing research indicates disparities in PCI access emerge both before and during STEMI treatment.
- The precise timing of when the most significant disparities in PCI receipt manifest remains unclear.
Purpose of the Study:
- To determine at which point in the patient care pathway the most substantial disparities in PCI receipt occur for STEMI patients presenting to an emergency department.
Main Methods:
- This cross-sectional study analyzed data from adult STEMI patients presenting to Florida hospitals between 2011 and 2021.
- Outcomes included presentation to PCI-capable hospitals, PCI receipt, transfer status, and PCI receipt post-transfer, compared across racial and ethnic groups.
- Logistic regression models controlled for demographic, clinical, and hospital factors to assess disparities in PCI receipt.
Main Results:
- Hispanic and Black patients were less likely to present to PCI-capable hospitals compared to White patients.
- Black patients showed lower PCI receipt rates when initially presenting to PCI-capable hospitals.
- Disparities in transfer rates and subsequent PCI receipt were also observed for Black and Hispanic patients presenting to non-PCI-capable hospitals.
Conclusions:
- Racial and ethnic disparities in PCI receipt for STEMI patients are evident at multiple stages of the care process.
- While the largest disparity in magnitude was observed in PCI receipt after transfer, the most impactful disparity, in terms of patient care, was related to initial presentation at PCI-capable facilities.
Importance:
Hispanic and non-Hispanic Black patients with ST-segment elevation myocardial infarction (STEMI) are less likely than White non-Hispanic patients to receive guideline-recommended percutaneous coronary intervention (PCI). Research suggests disparities arise before and during STEMI treatment, but it is unclear when the largest disparities in PCI emerge.
Objective:
To assess when in the care process the largest disparities in PCI receipt occur in patients with STEMI presenting to an emergency department.
Design, Setting, And Participants:
This cross-sectional study evaluated adult patients with STEMI presenting to Florida hospitals from January 1, 2011, to December 31, 2021. Data were analyzed from June 29, 2023, to May 29, 2025.
Exposure:
Patient race and ethnicity.
Main Outcomes And Measures:
The main outcomes were presentation to PCI-capable hospitals, receipt of PCI if initially presenting to PCI-capable hospitals, transfer if initially presenting to non-PCI capable hospitals, and receipt of PCI at receiving hospital if transferred. Logistic regression was used to compare outcomes for patients with STEMI by race and ethnicity, controlling for payer, age, sex, weekend presentation, time of presentation, comorbidities, and hospital characteristics.
Results:
Among 139 629 patients with STEMI included in the analysis, 68.81% were male. Mean (SD) age was 64.4 (13.0) years. A total of 9.09% identified as Black, 15.17% as Hispanic, 70.56% as White, and 5.17% as other or missing race. In adjusted analyses, Black (-1.8 [95% CI, -2.6 to 1.1] percentage points [pp]) and Hispanic (-3.1 [95% CI, -3.7 to -2.4] pp) patients were less likely than White patients to present to PCI-capable hospitals (P < .001 for both). Among patients initially presenting to PCI-capable hospitals, Black patients were less likely to receive PCI than White patients (-8.6 [95% CI, -9.5 to -7.7] pp; P < .001). Among patients initially presenting to non-PCI-capable hospitals, Black (-4.0 [95% CI, -6.4 to -1.5] pp; P = .001) and Hispanic (-4.2 [95% CI, -6.3 to -2.0] pp; P < .001) patients were less likely to be transferred than White patients. Among transferred patients, Black patients were less likely to undergo PCI at the receiving hospital than White patients (-13.3 [95% CI, -16.6 to -9.9] pp; P < .001).
Conclusions And Relevance:
In this cross-sectional study examining racial and ethnic disparities in receipt of PCI for patients with STEMI, racial and ethnic disparities persisted throughout the care process. The largest magnitude of disparity was PCI receipt if transferred, but the disparity with the largest impact was PCI receipt when initially presenting to PCI-capable hospitals.
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