Relationship of Race/Ethnicity With Door‐to‐Balloon Time and Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: Findings From Get With the Guidelines–Coronary Artery Disease

Abstract

Background: Prior studies have described racial/ethnic disparities in door-to-balloon (DTB) time for patients undergoing primary percutaneous coronary intervention (PCI). We sought to compare DTB time between different racial/ethnic groups undergoing primary PCI for ST-elevation myocardial infarction in Get With the Guidelines (GWTG). Hypothesis: There may be differences in D2B time associated with race/ethnicity. Methods: We identified 7445 patients undergoing primary PCI: white (n = 6365), African American (n = 568), and Hispanic (n = 512).Results: There were no differences in the median DTB time between white (74 minutes; intraquartile range [IQR], 54-99), African American (77 minutes; IQR, 57-100), and Hispanic (75 minutes; IQR, 56-100) (P = 0.13) patients. There were no crude differences in DTB time ≤90 minutes; however, after adjusting for confounders, African American race was associated with lower odds of DTB time ≤90 minutes (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.70-0.99; P = 0.04). This association was seen in African American males (OR: 0.66; 95% CI: 0.55-0.80) but not African American females (OR: 1.27; 95% CI: 0.96-1.68). Overall, Hispanic ethnicity was not associated with a difference in DTB time ≤90 minutes (OR: 0.98; 95% CI: 0.77-1.25; P = 0.88); although Hispanic males did have a slightly longer median DTB time compared with whites. During the study, the proportion of patients with DTB times ≤90 minutes increased for all groups, and mortality was similar between groups (white 3.8%, African American 3.0%, Hispanic 4.1%, P = 0.62). Conclusions: In GWTG-Coronary Artery Disease, small differences in DTB times persist among different races/ethnicities. However, the proportion achieving DTB times ≤90 minutes has increased substantially for all patients over time, and there was no association between race/ethnicity and in-hospital mortality.

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

“…21 Similarly, in STEMI patients undergoing primary PCI as part of the GWTG study, investigators found no association between race/ethnicity and in-hospital mortality. 13 In the analysis of 12 555 AMI patients in New York City, Hispanics were more likely to survive than whites, and among patients who were not revascularized, Hispanics were more likely to survive and be discharged than whites. 3 Having preexisting complications may worsen outcomes.…”

“…12 In STEMI patients undergoing primary PCI as part of the GWTG study, median door-toballoon times were marginally, but not significantly, longer for Hispanic patients than for non-Hispanic white patients, and Hispanic ethnicity was not associated with reduced odds of door-to-balloon times ≤90 minutes (a quality-of-care indicator for treatment of STEMI). 13 In the ACTION Registry-GWTG study, use of acute medications and primary PCI was similar in Hispanic and non-Hispanic patient groups, 20 and Hispanic patients in the NYS-PCI-RS study were found to have higher rates of surgical or PCI revascularization. 22 Other studies show lower rates of revascularization for Hispanic patients.…”

“…12 In a study of patients undergoing primary percutaneous coronary intervention (PCI) as part of the American Heart Association Get With The Guidelines (GWTG) study, insignificant differences were found in door-to-balloon times between white and black patients, with similar in-hospital mortality rates between groups. 13 However, after adjusting for confounding factors, being black was associated with a lower likelihood of doorto-balloon times of <90 minutes (a quality-of-care indicator for treatment of ST-segment elevation myocardial infarction [STEMI]) relative to being white. 13 In a study of Medicare beneficiaries with AMI who were admitted to hospitals without revascularization facilities, it was found that it took a median of 2 days to transfer black patients to a revascularization hospital, but a median of 1 day for whites (risk-standardized mortality rate in the revascularization hospitals did not differ between black and white patients).…”

“…13 However, after adjusting for confounding factors, being black was associated with a lower likelihood of doorto-balloon times of <90 minutes (a quality-of-care indicator for treatment of ST-segment elevation myocardial infarction [STEMI]) relative to being white. 13 In a study of Medicare beneficiaries with AMI who were admitted to hospitals without revascularization facilities, it was found that it took a median of 2 days to transfer black patients to a revascularization hospital, but a median of 1 day for whites (risk-standardized mortality rate in the revascularization hospitals did not differ between black and white patients). 14 In a cohort of 1 215 924 black and white Medicare beneficiaries (≥68 years) admitted with AMI between 2000 and 2005, black patients admitted to nonrevascularization hospitals were significantly less likely to be transferred to a hospital with revascularization facilities, and significantly less likely to receive revascularization than white patients.…”

“…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...…”