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

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ABSTRACT

Background: There 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 results: We 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.

Conclusions: Black 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.

No MeSH data available.


Symptom‐onset‐to‐door time according to race and substratified by insurance status.
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jah31765-fig-0005: Symptom‐onset‐to‐door time according to race and substratified by insurance status.

Mentions: Of the 466 (41%) patients transferred in from outside facilities, the median age was 59 years, 44% were blacks, and 80% were insured. Compared to those directly admitted, transferred patients were more likely to present in cardiogenic shock (P=0.05) and to require CABG (P<0.01), but this did not translate to a significant mortality difference at discharge (P=0.40). In the subset analysis excluding patients transferred from other hospitals, blacks were still more likely to present late after symptom onset: 47% of black patients presented to the emergency room “late” after symptom onset (>180 minutes) compared to 36% of white patients (P=0.01) (Figure 5).


Racial Difference in Symptom Onset to Door Time in ST Elevation Myocardial Infarction
Symptom‐onset‐to‐door time according to race and substratified by insurance status.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121481&req=5

jah31765-fig-0005: Symptom‐onset‐to‐door time according to race and substratified by insurance status.
Mentions: Of the 466 (41%) patients transferred in from outside facilities, the median age was 59 years, 44% were blacks, and 80% were insured. Compared to those directly admitted, transferred patients were more likely to present in cardiogenic shock (P=0.05) and to require CABG (P<0.01), but this did not translate to a significant mortality difference at discharge (P=0.40). In the subset analysis excluding patients transferred from other hospitals, blacks were still more likely to present late after symptom onset: 47% of black patients presented to the emergency room “late” after symptom onset (>180 minutes) compared to 36% of white patients (P=0.01) (Figure 5).

View Article: PubMed Central - PubMed

ABSTRACT

Background: There are poorer outcomes following ST elevation myocardial infarction in blacks compared to white patients despite comparable door&#8208;to&#8208;reperfusion time. We hypothesized that delays to hospital presentation may be contributory.

Methods and results: We conducted a retrospective analysis of the 1144 patients admitted for STEMI in our institution from 2008 to 2013. The door&#8208;to&#8208;balloon time (D2BT) and symptom&#8208;onset&#8208;to&#8208;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&plusmn;13&nbsp;years; 56% of this population was black and 41% was white. Males accounted for 66% of this population. The median D2BT was 60&nbsp;minutes (interquartile range [IQR] 42&ndash;82), and median SODT was 120&nbsp;minutes (IQR 60&ndash;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&ndash;1400] vs 120 [IQR 60&ndash;560] minutes, P&lt;0.01) and were more likely to be uninsured (P&lt;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&lt;0.01). A subset analysis excluding transferred patients showed similar results.

Conclusions: Black 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.

No MeSH data available.