Differences in Treatment Patterns and Outcomes Between Hispanics and Non-Hispanic Whites Treated for ST-Segment Elevation Myocardial Infarction: Results From the NCDR ACTION Registry–GWTG

Perspective:

The following are 10 points to remember about this article:

1. Ethnic disparities in contemporary ST-segment elevation myocardial infarction (STEMI) management have not been well characterized.

2. The National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcome Network–Get With The Guidelines Registry (ACTION Registry–GWTG), the largest national database including consecutive acute coronary syndrome patients, provides a unique opportunity to compare contemporary treatment patterns and outcomes between Hispanic and non-Hispanic white STEMI patients.

3. Hispanics represented 4.1% of STEMI patients in ACTION Registry–GWTG.

4. Significant delays in initial triage and reperfusion were observed for Hispanic patients. Specifically, times to presentation, first electrocardiogram, and reperfusion therapy were longer in Hispanic patients.

5. Use of acute medications (aspirin 98%, clopidogrel 87%, beta-blockers 95%, anticoagulation 89%, and glycoprotein IIb/IIIa inhibitors 70%) and primary percutaneous coronary intervention (PCI) was similar between groups.

6. Logistic generalized estimating equation modeling examined associated risk-adjusted mortality, adjusting for patient-level risk factors adapted from a validated mortality risk model and hospital characteristics (number of beds, geographic location, academic status, PCI capability, and percent of Hispanic patients treated).

7. Despite differences in clinical characteristics and delays to reperfusion, the adjusted in-hospital mortality was similar between ethnic groups.

8. In-hospital use of evidence-based and discharge therapies was remarkably similar between ethnic groups, and provides reassuring evidence of improvements instituted in the health system to eliminate racial/ethnic treatment disparities, a principal goal of Healthy People 2010.

9. The relationship between hospital care, in-hospital outcomes, as well as its long-term follow-up implications certainly requires additional research.

10. Quality improvement initiatives and education efforts specifically designed for the Hispanic population are warranted.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS

Keywords: Healthy People Programs, Myocardial Infarction, Acute Coronary Syndrome, Follow-Up Studies, Hospital Mortality, European Continental Ancestry Group, Risk Factors, Ticlopidine, Electrocardiography, Hispanic Americans, Percutaneous Coronary Intervention, Triage, Minority Groups, Quality Improvement, Registries, Cardiovascular Diseases, Quality Assurance, Health Care, Myocardial Reperfusion, Logistic Models, Platelet Glycoprotein GPIIb-IIIa Complex


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