Racial Difference in Symptom Onset to Door Time in ST Elevation Myocardial Infarction

Abstract

BackgroundThere are poorer outcomes following ST elevation myocardial infarction in blacks compared to white patients despite comparable door‐to‐reperfusion time. We hypothesized that delays to hospital presentation may be contributory.Methods and ResultsWe conducted a retrospective analysis of the 1144 patients admitted for STEMI in our institution from 2008 to 2013. The door‐to‐balloon time (D2BT) and symptom‐onset‐to‐door time (SODT) were compared by race. Bivariate analysis was done comparing the median D2BT and SODT. Stratified analyses were done to evaluate the effect of race on D2BT and SODT, accounting for insurance status, age, sex and comorbidities. The mean age was 59±13 years; 56% of this population was black and 41% was white. Males accounted for 66% of this population. The median D2BT was 60 minutes (interquartile range [IQR] 42–82), and median SODT was 120 minutes (IQR 60–720). There was no significant difference in D2BT by race (P=0.86). Black patients presented to the emergency room (ER) later than whites (SODT=180 [IQR 60–1400] vs 120 [IQR 60–560] minutes, P<0.01) and were more likely to be uninsured (P<0.01). After controlling for comorbidities, insurance, and socioeconomic status, blacks were 60% more likely to present late after a STEMI (OR 1.6, P<0.01). A subset analysis excluding transferred patients showed similar results.ConclusionsBlack patients present later to the ER after STEMI with no difference in D2BT compared to whites. This difference in time to presentation may be one of the factors accounting for poor outcomes in this population.

Factors Affecting Time to Presentation in ST-Elevation Myocardial Infarction(FAT STEMI)

“…These findings contradict a previous study in which African Americans had longer TTP than Caucasians [8]. Although the reason for the contradictory findings was not shown by our study, not all parameters were similar to the prior analysis.…”

Racial and ethnic disparities in coronary, vascular, structural, and congenital heart disease

“…Predictors of lack of treatment were atypical symptoms, patient and institutional delay, and admission diagnosis other than STEMI. In another study, Black patients presented to the emergency room (ER) 60 min later than Whites with STEMI, but door‐to‐balloon times were similar 12 …”

Understanding and Informing Community Emergency Cardiovascular Disease Preparedness during the COVID-19 Pandemic: Stroke Ready

“…5 This increase in prevalence among Black Americans may further exacerbate current racial disparities in pre-hospital delay; 6 compared to their white counterparts, Black Americans experience greater stroke and AMI pre-hospital delay, and lower treatment rates. 7 , 8 , 9 , 10 Thus, in the context of an ongoing community-engaged, health behavior theory-based, peer educator-led, community-wide stroke preparedness intervention, Stroke Ready, we sought to understand the community perception of seeking acute stroke and AMI care during the COVID-19 pandemic. Due to the urgent clinical and public health implications, we opted to use a rapid assessment approach in order to inform ongoing and future public health campaigns both locally and nationally.…”