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Race-Based Differences and STEMI Outcomes
Quick Takes
- Findings highlight persistence of important racial and ethnic disparities in STEMI care in the United States. Hispanic White and Black patients were less likely to receive and achieve time-based STEMI metrics (including door-to-ECG, arrival-to-PCI, and first medical contact-to-PCI times).
- In-hospital mortality was significantly higher in Hispanic White women (OR, 1.39; 95% CI, 1.12–1.72) compared to non-Hispanic White women but similar in Black patients compared to non-Hispanic White patients.
Study Questions:
What is the effect of contemporary ST-segment–elevation myocardial infarction (STEMI) systems of care on racial and ethnic disparities in achieving time-to-treatment goals and mortality in STEMI?
Methods:
A total of 178,062 patients with STEMI (52,293 women and 125,769 men) enrolled in the American Heart Association Get With The Guidelines–Coronary Artery Disease (GWTG-CAD) registry between January 1, 2015, and December 31, 2021. Patients were stratified into and outcomes compared among three racial and ethnic groups: non-Hispanic White, Hispanic White, and Black. The primary outcomes were the proportions of patients achieving the following STEMI process metrics: prehospital electrocardiogram (ECG) obtained by emergency medical services; hospital arrival to ECG obtained within 10 minutes for patients not transported by emergency medical services; arrival-to–percutaneous coronary intervention (PCI) time within 90 minutes; and first medical contact (FMC)–to-device time within 90 minutes. A secondary outcome was in-hospital mortality. Analyses were performed separately in women and men, and all outcomes were adjusted for age, comorbidities, acuity of presentation, insurance status, and socioeconomic status measured by social vulnerability index based on patients’ county of residence.
Results:
Compared with non-Hispanic White patients with STEMI, Hispanic White patients and Black patients had lower odds of receiving a prehospital ECG and achieving targets for door-to-ECG, door-to-device, and first medical contact–to-device times. These racial disparities in treatment goals were observed in both women and men, and persisted in most cases after multivariable adjustment. Compared with non-Hispanic White women, Hispanic White women had higher adjusted in-hospital mortality (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.12–1.72), whereas Black women did not (OR, 0.88; 95% CI, 0.74–1.03). Compared with non-Hispanic White men, adjusted in-hospital mortality was similar in Hispanic White men (OR, 0.99; 95% CI, 0.82–1.18) and Black men (OR, 0.96; 95% CI, 0.85–1.09).
Conclusions:
Race- or ethnicity-based disparities persist in STEMI process metrics in both women and men, and mortality differences are observed in Hispanic White compared with non-Hispanic White women. Further research is essential to evolve systems of care to mitigate racial differences in STEMI outcomes.
Perspective:
Findings highlight persistence of important racial and ethnic disparities in STEMI care in the United States. Hispanic White and Black patients were less likely to receive and achieve time-based STEMI metrics (including door-to-ECG, arrival-to-PCI, and FMC-to-PCI times). In-hospital mortality was significantly higher in Hispanic White women compared to Non-Hispanic White women but similar in Black patients compared to Non-Hispanic White patients. Study results may still be limited by observational design but are similar to prior analyses from the GWTG-CAD registry. Study findings are a reminder that more research is needed to improve and abolish race- and ethnicity-based disparities in cardiovascular care.
Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Vascular Medicine, Chronic Angina
Keywords: African Americans, Coronary Artery Disease, Electrocardiography, Emergency Medical Services, Ethnic Groups, Healthcare Disparities, Hispanic Americans, Myocardial Infarction, Percutaneous Coronary Intervention, Race Factors, Socioeconomic Factors, ST Elevation Myocardial Infarction
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