Abstract
Background:
Ethnic differences have been reported in the treatment and outcomes of patients with non-ST-segment elevation myocardial infarction (non-STEMI). Potential ethnic disparities in contemporary STEMI management have not been well characterized.
Methods:
We compared practice patterns and outcomes between 1,654 Hispanics (H) (4.1%) and 38,844 non-Hispanic Whites (NHW) treated for STEMI in ACTION Registry-GWTG between 01-2007 and 03-2009. Logistic generalized estimating equation modeling was used to examine associated risk-adjusted mortality.
Results:
Hispanic patients more frequently had diabetes (32% vs 21%, p<0.0001), whereas older age (median 61 vs 57, P<0.0001), female gender (30% vs 21%, p<0.0001), smoking (43% vs 38%, p<0.0001), dyslipidemia (55% vs 51%, p<0.006) and prior MI (19% vs 15%, p<0.0002) were more prevalent in the NHW group. While use of acute medications (aspirin, clopidogrel, B Blockers and GPIIb/IIIa inhibitors) was similar between groups, significant differences and delays in initial triage and reperfusion were observed (Table). After adjustment for patient and hospital characteristics, in-hospital mortality was similar in H and NHW patients (OR 1.07; 95% CI 0.81, 1.43, p=0.63).
Conclusions:
Despite similar in-hospital mortality, Hispanic STEMI patients had significant differences in process of care with longer triage and treatment delays than non-Hispanic Whites. As the fastest growing minority in the United States, this population needs further efforts to optimize their care processes
Hispanics
Non-Hispanic Whites
p value
Ambulance use
41.5%
47.0%
<0.0001
Pre-Hospital EKG
32.8%
37.5%
<0.0001
Onset of pain to arrival (median)
2.0 hrs
1.6 hrs
<0.0001
Arrival to EKG (median)
8 min
6 min
<0.0001
Arrival to EKG<10 min
61.2%
69.3%
<0.0001
Reperfusion therapy
91.6%
93.1%
0.04
Arrival to PCI (median)
74 min
69 min
<0.0001
DTB <90 min
69.4%
77.5%
<0.0001