Population-level differences in revascularization treatment and outcomes among various United States subpopulations

Table 3 Summary of disparities in acute myocardial infarction co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in blacks

Co-morbidities and presentation symptoms

More likely than whites to have dyslipidemia, hypertension, obesity, insulin resistance, hyperglycemia, diabetes, and chronic kidney disease and to be physically inactive, smoke, and have poor eating habits[2]

More likely than whites to be younger and female and to have hypertension, diabetes, congestive heart failure, renal insufficiency, and history of smoking and stroke; less likely to have private insurance or cardiology care and to be uninsured[74]

More likely than whites to have Medicaid as insurer; to have no education beyond high school; to have low income; and to have a history of congestive heart failure, hypertension, and diabetes[76]

Likely to be younger and to have less education than whites; to have more hypertension, diabetes, higher BMI, and more current tobacco use; also more likely to experience palpitations, chest pressure, and chest pain[77]

More likely than whites to be younger and female and to have more hypertension, diabetes, renal insufficiency, history of smoking, congestive heart failure, previous MI, history of gastrointestinal bleeding, and lower baseline hemoglobin; also more likely to be on Medicaid or uninsured[78]

Care/medical resources

Less likely to be treated with either PCI or CABG within 3 mo of AMI than whites[23]

Longer door-to-drug and door-to-balloon times than for whites[79]

Less likely than whites to have door-to-balloon times < 90 min[80]

Likely to be transferred to a revascularization hospital more slowly than whites[81]

Less likely than whites to receive revascularization treatment[82]

Less likely than whites or Hispanics to receive revascularization treatment[83]

Less likely to be treated with revascularization than whites regardless of insurance status[84]

Less likely than whites to receive cardiac catheterization, PTCA, or CABG[85]

Persistently lower PCI rates in blacks compared to whites[86]

Less likely than whites to be transferred to a hospital with revascularization services or to be revascularized[87]

Less likely than whites to take their cardiac medications, to undergo non–protocol mandated angiography, or to receive a stent if undergoing PCI; less procedural success with PCI[89]

Outcomes

More likely to be discharged alive when not treated with revascularization than whites not receiving revascularization[83]

Lower mortality than in whites at 30 d post-AMI but higher thereafter[87]

Higher rates of recurrent AMI, congestive heart failure, and mortality than whites at 5 yr post-PCI[88]

Higher risk of death, recurrent MI, or re-hospitalization than whites[89]

Higher risk of death than whites following CABG[91]

More likely than whites to have adverse cardiac outcomes at 1 yr post-revascularization[92]

Consistently more likely than whites to have AMI re-hospitalization at 1 yr[93]

Both with and without pre-operative β-blockers, shorter median survival times with CABG than white patients[96]

PTCA: Percutaneous transluminal coronary angioplasty; AMI: Acute myocardial infarction; BMI: Body mass index; CABG: Coronary arterybypass grafting; PCI: Percutaneous coronary intervention.