Log in to MyACC
Race, Ethnicity, Sex Disparities in Patients With STEMI and Cardiogenic Shock
Quick Takes
- Among patients presenting with STEMI and cardiogenic shock, women and in particular, minority women (Black and Hispanic) have increased odds of in-hospital mortality compared to White men.
- Minorities and women are less likely to receive life-saving therapies such as revascularization and mechanical support.
- Race, ethnicity, and sex-based disparities continue to affect important outcomes in the highest risk patients presenting with STEMI and cardiogenic shock.
Study Questions:
What is the combined impact of race, ethnicity, and sex on in-hospital outcomes among patients presenting with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS)?
Methods:
Data were obtained and analyzed from the National Inpatient Sample from January 2006 to September 2015 for hospitalizations with STEMI and CS. The associations between sex, race, ethnicity, and outcomes were examined using complex-samples multivariate logistic or generalized linear model regressions.
Results:
Of a total of 159,339 patients with STEMI and CS, 57,839 (36.3%) were women. In-hospital mortality was higher for all women (range 40-45.4%) compared with men (range 30.4-34.7%). Women (adjusted odds ratio [aOR], 1.11; 95% confidence interval [CI], 1.06-1.16; p < 0.001) as well as Black (aOR, 1.18; 95% CI, 1.04-1.34; p = 0.011) and Hispanic (aOR, 1.19; 95% CI, 1.06-1.33; p = 0.003) men had higher odds of in-hospital mortality compared with White men, with Hispanic women having the highest odds of in-hospital mortality (aOR, 1.46; 95% CI, 1.26-1.70; p < 0.001). Women were older (age 69.8 years vs. 63.2 years), had more comorbidities, and underwent fewer invasive cardiac procedures, including revascularization, right heart catheterization, and mechanical circulatory support (MCS).
Conclusions:
There are significant racial, ethnic, and sex differences in procedural utilization and clinical outcomes in patients with STEMI and CS. Women are less likely to undergo invasive cardiac procedures, including revascularization and MCS. Women as well as Black and Hispanic patients have a higher likelihood of death compared with White men.
Perspective:
Barring the limitations of this retrospective analysis from 2006-2015, authors show the presence of significantly higher in-hospital mortality among women and in particular, minority women (Black and Hispanic) compared to white men. In addition, there is a treatment gap with women and minorities less likely to undergo revascularization and mechanical support for CS. A potential explanation for these findings in this high-risk group of patients is complex and in part could be due to disparities in timely access to care, socioeconomic sand educational status, and presence of implicit bias in our current approach to treatment. The authors suggest use of shock protocols to standardize treatment and also stress the importance of adequate representation of women and minorities in clinical trials to help narrow the gap in outcomes based on sex, ethnicity, and race. Whether trends have changed in more contemporary practice remains to be determined.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and SIHD, Acute Heart Failure, Interventions and ACS, Interventions and Vascular Medicine, Chronic Angina
Keywords: Acute Coronary Syndrome, Cardiac Catheterization, Comorbidity, Educational Status, Ethnic Groups, Health Services Accessibility, Hospital Mortality, Inpatients, Myocardial Infarction, Myocardial Revascularization, Outcome Assessment, Health Care, Secondary Prevention, Sex Characteristics, Shock, Cardiogenic, Socioeconomic Factors, ST Elevation Myocardial Infarction
< Back to Listings
