Racial Disparities in Left Main Stenting: Insights from a Real World Inner City Population

Mohamad, Tamam; Panaich, Sidakpal; Alani, Anas; Badheka, Apurva; Shenoy, Maithili; Mohamad, Bashar; Kanaan, Eyas; Ali, Omaima; Elder, Mahir; Schreiber, Theodore

doi:10.1111/j.1540-8183.2013.12012.x

Cited by 10 publications

(6 citation statements)

References 39 publications

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“…Longer than whites More likely than whites More likely than whites Door-to-drug times 12 Prescribed aspirin 5 Survive and be discharged (when not treated with revascularization) 3 Door-to-balloon times 12 Rehospitalization (nonwhites) 11 More likely than whites Less likely than whites Recurrent AMI (nonwhites) 11 Slower transfer to revascularization hospital 14 Diagnostic cardiac catheterization 5 Recurrent AMI (5 years post-PCI) 32 Less likely than whites Catheterization 31,33 Rehospitalized for AMI (<1 year post-AMI) 18 Door-to-balloon times <90 minutes 13 Non-protocol mandated angiography (nonwhites) 11 Death (nonwhites) 11 Transfer to hospital with revascularization services 15 Use of lidocaine 6 Death following CABG (nonwhites) 28 PCI 5,7 Mortality (>30 days post-AMI) 15 PCI or CABG within 3 months of AMI 17 Mortality (5 years post-PCI) 32 Revascularization (admitted to nonrevascularization hospital) 15 Rehospitalization or death within 1 year post-CHD hospitalization 30 Revascularization 3,16,34 Adverse cardiac outcomes (1-year post revascularization) 35 6 Receive stent if undergoing PCI (nonwhites) 11 Less likely than whites Stress test 33 Procedural success with PCI (nonwhites) 11 Echocardiogram 33 Mortality <30 days post-AMI 15 Drug-eluting stents 4 Prescribed prasugrel 4 Prescribed clopidogrel 5 Prescribed GP IIb/IIIa inhibit...…”

Section: Delays Treatments Outcomesmentioning

confidence: 99%

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Graham

2016

Clinical Cardiology

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In the United States, different races, ethnicities, and their subgroups experience disparities regarding acute coronary syndrome (ACS) and myocardial infarction (MI). This review highlights these differences across 4 stages that comprise the ACS/MI narrative: (1) patient demographics, (2) patient comorbidities and health risks, (3) treatments and their delays, and (4) outcomes. Overall, black and Hispanic ACS/MI patients are more likely to present with comorbidities, experience longer delays before treatment, and suffer worse outcomes when compared with non‐Hispanic white patients. More specifically, across the studies analyzed, black and Hispanic ACS/MI patients were consistently more likely to be younger or female, or to have hypertension or diabetes, than non‐Hispanic white patients. ACS/MI disparities also exist among Asian populations, and these are briefly outlined. However, black, Hispanic, and non‐Hispanic white ACS/MI patients were the 3 most‐studied racial and ethnic groups, indicating that additional studies of other minority groups, such as Native Americans, Asian populations, and black and Hispanic subgroups, are needed for their utility in reducing disparities. Despite notable improvement in ACS/MI treatment quality measures over recent decades, disparities persist. Causes are complex and extend beyond the healthcare system to culture and patients' personal characteristics; sophisticated solutions will be required. Continued research has the potential to further reduce or eliminate disparities in the comorbidities, delays, and treatments surrounding ACS and MI, extending healthy lifespans of many underserved and minority populations, while reducing healthcare costs.

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Section: Delays Treatments Outcomesmentioning

confidence: 99%

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Graham

2016

Clinical Cardiology

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“…Mortality and revascularization rates were similar among whites, blacks, and Asians [36]. In a separate single site study among 227 patients documented to have left main coronary artery disease who underwent PCI at an urban academic medical center between March 2000 and December 2008, African American race was associated with an almost fourfold higher odds of death or recurrent myocardial infarction compared with whites and others 1 year after revascularization, after adjustment for age, sex, and comorbid conditions [37]. Finally, in a large cohort study that utilized the nationwide inpatient sample of 1,924,413 patients admitted for myocardial infarction between 2006 and 2008, blacks had a 35%higher adjusted odds versus whites to have a cerebrovascular accident following an acute myocardial infarction [38].…”

Section: Complications and Other Factorsmentioning

confidence: 99%

Differential Outcomes by Race and Ethnicity in Patients with Coronary Heart Disease: A Contemporary Review

Mochari‐Greenberger

Mosca

2015

Curr Cardiovasc Risk Rep

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Coronary heart disease (CHD) is a leading cause of death for people of most ethnicities in the USA. However, several racial and ethnic minority groups are disproportionately burdened by CHD and experience higher mortality rates and rehospitalization rates compared with whites. Contemporary CHD research has been dedicated in part to broadening our understanding of the root causes of racial and ethnic disparities in CHD outcomes. Several factors contribute, including socioeconomic and comorbid conditions. These factors may be amenable to change, and targets for initiatives to reduce disparities and improve CHD outcomes. In this article, we review the recently published research related to the distribution and determinants of racial and ethnic differences in CHD outcomes in the USA.

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“…received fewer therapy with antiplatelets, beta-blockers, lipid-lowering medication [ 13 , 29 ] and reperfusion therapy [ 13 ]. In addition obtaining similar invasive procedures in treatment of STEMI was unlikely for ethnic minority members in the US, where racial disparities led to lower rates of primary PCI and longer door-to-balloon times in Afro-Americans [ 30 , 31 ]. Alter et al reported a negative association of SES and access to cardiac services, leading to elevated long -term mortality for patients from low SES areas even for Canada with its universal health care system [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis

Schmucker

Seide

Wienbergen

et al. 2017

BMC Cardiovasc Disord

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BackgroundThe importance of socioeconomic status (SES) for coronary heart disease (CHD)-morbidity is subject of ongoing scientific investigations. This study was to explore the association between SES in different city-districts of Bremen/Germany and incidence, severity, treatment modalities and prognosis for patients with ST-elevation myocardial infarctions (STEMI).MethodsSince 2006 all STEMI-patients from the metropolitan area of Bremen are documented in the Bremen STEMI-registry. Utilizing postal codes of their home address they were assigned to four groups in accordance to the Bremen social deprivation-index (G1: high, G2: intermediate high, G3: intermediate low, G4: low socioeconomic status).ResultsThree thousand four hundred sixty-two consecutive patients with STEMI admitted between 2006 and 2015 entered analysis. City areas with low SES showed higher adjusted STEMI-incidence-rates (IR-ratio 1.56, G4 vs. G1). This elevation could be observed in both sexes (women IRR 1.63, men IRR 1.54) and was most prominent in inhabitants <50 yrs. of age (women IRR 2.18, men IRR 2.17). Smoking (OR 1.7, 95%CI 1.3–2.4) and obesity (1.6, 95%CI 1.1–2.2) was more prevalent in pts. from low SES city-areas. While treatment-modalities did not differ, low SES was associated with more extensive STEMIs (creatine kinase > 3000 U/l, OR 1.95, 95% CI 1.4–2.8) and severe impairment of LV-function post-STEMI (OR 2.0, 95% CI 1.2–3.4). Long term follow-up revealed that lower SES was associated with higher major adverse cardiac or cerebrovascular event (MACCE)-rates after 5 years: G1 30.8%, G2 35.7%, G3 36.0%, G4 41.1%, p (for trend) = 0.02. This worse prognosis could especially be shown for young STEMI-patients (<50 yrs. of age) 5-yr. mortality-rates(G4 vs. G1) 18.4 vs. 3.1%, p = 0.03 and 5-year-MACCE-rates (G4 vs. G1) 32 vs. 6.3%, p = 0.02.ConclusionsThis registry-data confirms the negative association of low socioeconomic status and STEMI-incidence, with higher rates of smoking and obesity, more extensive infarctions and worse prognosis for the socio-economically deprived.

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Racial Disparities in Left Main Stenting: Insights from a Real World Inner City Population

Abstract: In our study of patients with unprotected LMCA disease, AA race, and age were significantly predictive of poor prognosis following revascularization, while gender had no predictive value in prognosticating cardiovascular mortality.

Cited by 10 publications

References 39 publications

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

Differential Outcomes by Race and Ethnicity in Patients with Coronary Heart Disease: A Contemporary Review

Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis

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