Race-based Differences in Revascularization after MI

IOWA CITY, Iowa June 12 -- Black Medicare patients were less likely to receive coronary revascularization for acute MI than white patients, even if the hospital offered those services.

Among patients admitted to hospitals with revascularization facilities, 34.3% of blacks had either PCI or CABG, but 50.2% of whites had the procedures (P=0.001). Among patients initially admitted to hospitals that did not have revascularization capability, 18.3% of black patients eventually had PCI or CABG compared with 25.9% of white patients (P=0.001). So found Ioana Popescu, M.D., of the VA Medical Center and the University of Iowa here, and colleagues.

Black patients admitted to hospitals without revascularization were also less likely to be transferred (25.2% versus 31.0%; P

After adjustment for sociodemographics, comorbidity, severity of illness, and distance to the nearest hospital with revascularization services, the likelihood of transfer to such a facility was lower for black patients compared with white patients (hazard ratio [HR], 0.78; 95% confidence interval 0.75-0.81; P

The study was unable to account for important clinical indications for transfer and revascularization, such as differentiating between patients with ST-segment elevation and non-ST-segment elevation.

Finally, the investigators noted that risk adjustment models based on administrative data might affect the reliability of individual diagnosis codes and may not capture long-term prognostic factors, such as body mass index and smoking.

The current study provides evidence that the racial differences described here persist even for patients transferred from hospitals without full invasive cardiac services to hospitals that do provide these services, the investigators said.

These differences could be caused by unmeasured clinical or socioeconomic factors, or patient or physician preferences, but are unlikely to be related to differences in access to hospitals providing revascularization procedures.

Although differences in revascularization may reflect overuse of procedures in white patients, receiving revascularization treatment could also explain some of the differences in longer-term mortality in black patients and may represent a broader marker of differences for their post-MI care, the investigators said.

"Thus, as data on the benefits of revascularization in different patient subgroups continue to emerge, efforts to standardize post-acute MI treatment with evidence-based protocols and aggressive risk-factor management are essential to eliminating racial differences in care for acute MI and other coronary syndromes," Dr. Popescu and her colleagues concluded