Black patients had significantly lower rates of revascularization in both STEMI and NSTEMI and lower rates of catheterization in NSTEMI, though protocol-driven STEMI care showed fewer disparities.
Observational
Yes
Do race and sex disparities exist in the contemporary management and outcomes of patients with STEMI and NSTEMI?
Racial disparities in myocardial infarction management appear to be less prevalent in heavily protocol-driven processes like STEMI care compared to less algorithmic NSTEMI care.
BACKGROUND: Race and sex have been shown to affect management of myocardial infarction (MI); however, it is unclear if such disparities exist in contemporary care of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). HYPOTHESIS: Disparities in care will be less prevalent in more heavily protocol-driven management of STEMI than the less algorithmic care of NSTEMI. METHODS: Data were collected from the ACTION Registry-GWTG database to assess care differences related to race and sex of patients presenting with NSTEMI or STEMI. For key treatments and outcomes, adjustments were made including patient demographics, baseline comorbidities, and markers of socioeconomic status. RESULTS: Key demographic variables demonstrate significant differences in baseline comorbidities; black patients had higher incidences of hypertension and diabetes, and women more frequently had diabetes. With few exceptions, rates of acute and discharge medical therapy were similar by race in any sex category in both STEMI and NSTEMI populations. Rates of catheterization were similar by race for STEMI but not for NSTEMI, where both black men and women had lower rates of invasive therapy. Rates of revascularization were significantly lower for black patients in both the STEMI and NSTEMI groups regardless of sex. Rates of adverse events differed by sex, with disparities for death and major bleeding; after adjustment, rates were similar by race within sex comparisons. CONCLUSIONS: In this contemporary cohort, although there are differences by race in presentation and management of MI, heavily protocol-driven processes seem to show fewer racial disparities.
Anstey et al. (Thu,) conducted a observational in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Race and sex (exposure) vs. Comparisons across race and sex categories was evaluated on Care differences (medical therapy, catheterization, revascularization) and adverse events (death, major bleeding). Black patients had significantly lower rates of revascularization in both STEMI and NSTEMI and lower rates of catheterization in NSTEMI, though protocol-driven STEMI care showed fewer disparities.