Key result
African American race was associated with less frequent use of glycoprotein IIb/IIIa receptor inhibitors in UA/NSTEMI compared to white race (OR 0.41; 95% CI 0.19-0.91).
Why the study?
Does race impact the acute evaluation, medical treatment, and invasive testing of adults presenting with chest pain?
Observational (n=7,935)
Yes
Does race impact the acute evaluation, medical treatment, and invasive testing of adults presenting with chest pain?
Effect estimate: OR 0.41 (95% CI 0.19-0.91)
Racial disparities in the management of acute chest pain extend beyond cardiac catheterization to include acute evaluation and guideline-directed medical therapies.
Highlights potential racial disparities in UA/NSTEMI medical therapy; extends evidence beyond catheterization but remains hypothesis-generating.
African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and non interventional treatment.Data on adults with chest pain (N = 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n = 400; 2) unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), n = 1,153; and 3) nonacute coronary syndrome chest pain (non-ACS CP), n = 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non-ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD).African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95% CI = 0.19 to 0.91). African Americans with non-ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non-ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95% CI = 0.29 to 0.71 and OR, 0.40; 95% CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95% CI = 0.40 to 0.68 and OR, 0.68; 95% CI = 0.47 to 0.99).Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation.
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Venkat et al. (2003) conducted an observational in Chest pain and acute coronary syndromes (n=7,935). African American race vs. White race was evaluated on Receipt of glycoprotein IIb/IIIa receptor inhibitors in UA/NSTEMI (OR 0.41, 95% CI 0.19-0.91). African American race was associated with less frequent use of glycoprotein IIb/IIIa receptor inhibitors in UA/NSTEMI compared to white race (OR 0.41; 95% CI 0.19-0.91).
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