Racial Differences in the Use of Cardiac Procedures in Patients With Acute Myocardial Infarction

BACKGROUND: Although numerous studies have shown that Black patients are less likely than White patients to undergo cardiac procedures, most of these studies did not consider clinical and demographic factors that could account for observed racial differences. OBJECTIVE: To determine if there are racial differences in the use of coronary angiography and revascularization procedures in patients with acute myocardial infarction, while controlling for multiple potentially important demographic and clinical variables. METHODS: In this retrospective cohort study, data were obtained from medical records of 642 consecutive Black and White patients with acute myocardial infarction at a regional cardiac referral center in southern New England. RESULTS: Blacks were significantly less likely than Whites to undergo angiography (p =.004; adjusted odds ratio =.36; 95% confidence interval =.18 -.72) and revascularization procedures (p =.006; adjusted odds ratio =.21; 95% confidence interval =.07 -.64). In the subgroup admitted directly to the hospital (n = 465), rather than transferred in from outlying hospitals, there were no racial differences in the use of angiography, but Blacks were significantly less likely to undergo revascularization procedures (p =.004; adjusted odds ratio =.18; 95% confidence interval =.06 -.58). CONCLUSIONS: In patients hospitalized with acute myocardial infarction, there are substantial racial differences in the use of angiography and revascularization procedures that cannot be explained by clinical or demographic factors.