Ethnic disparities in care and outcomes of non-ST-segment elevation myocardial infarction: a nationwide cohort study.

Abstract

BACKGROUND: Little is known about ethnic disparities in care and clinical outcomes of patients admitted with non-ST-segment elevation myocardial infarction (NSTEMI) in national cohorts from universal healthcare systems derived from Europe. METHODS & RESULTS: We identified 280,588 admissions with NSTEMI in the United Kingdom (UK) Myocardial Infarction National Audit Project (MINAP), 2010-2017, including White patients (n?=?258,364) and Black, Asian and Minority Ethnic (BAME) patients (n?=?22,194). BAME patients were younger (66 years vs. 73 years, P?<?0.001) and more frequently had hypertension (66% vs 54%, P?<?0.001), hypercholesterolemia (49% vs 34%, P?<?0.001) and diabetes (48% vs 24%, P?<?0.001). BAME patients more frequently received invasive coronary angiography (80% vs 68%, P?<?0.001), percutaneous coronary intervention (PCI) (52% vs 43%, P?<?0.001) and coronary artery bypass graft surgery (9% vs 7%, P?<?0.001). Following propensity score matching, BAME compared with White patients had similar in-hospital all-cause mortality (OR:0.91, CI: 0.76-1.06, P?=?0.23), major bleeding (OR: 0.99, CI: 0.75 - 1.25, P?=?0.95), reinfarction (OR: 1.15, CI: 0.84 - 1.46, P?=?0.34) and major adverse cardiovascular events (MACE) (OR:0.94, CI: 0.80-1.07, P?=?0.35). CONCLUSION: BAME patients with NSTEMI had higher cardiometabolic risk profiles and were more likely to undergo invasive angiography and revascularization, with similar clinical outcomes as those of their White counterparts. Among the quality indicators assessed, there is no evidence of care disparities among BAME patients presenting with NSTEMI.

Citation

Mamas, & Rashid. (2021). Ethnic disparities in care and outcomes of non-ST-segment elevation myocardial infarction: a nationwide cohort study. European Heart Journal - Quality of Care and Clinical Outcomes, https://doi.org/10.1093/ehjqcco/qcab030

• Acceptance Date: Apr 19, 2021
• Publication Date: Apr 21, 2021
• Journal: European Heart Journal - Quality of Care and Clinical Outcomes
• Print ISSN: 2058-5225
• Publisher: Oxford University Press
• DOI: https://doi.org/10.1093/ehjqcco/qcab030
• Keywords: NSTEMI; Ethnicity; BAME; Mortality
• Publisher URL: https://academic.oup.com/ehjqcco/advance-article/doi/10.1093/ehjqcco/qcab030/6248090