Abstract 4551: Are There Racial/Ethnic Disparities in Use of Drug-Eluting vs. Bare Metal Stents in Acute Myocardial Infarction Patients?
Background: Blacks may be at elevated risk of post-stent restenosis. Drug-eluting stents (DES) reduce the risk of restenosis and revascularization compared with bare metal stents (BMS). Few population-based studies have examined demographic patterns of DES use. We investigated racial/ethnic differences in use of DES among acute myocardial infarction (AMI) patients who received PCI.
Methods: Hospital discharge data were analysed. The study population included all AMI (ICD-9-CM 410) inpatients aged 18+ who received PCI in Floridal during 2004 –2006 (n=55,529). We further restricted our analysis to the 93% who received a stent (n=51,827). Procedure codes identified DES (ICD-9 CM 36.07) and BMS (ICD-9 CM 36.06). We examined three ethnic groups (Black non-Hispanics, White non-Hispanics, and Hispanics), and five payers (Medicare, Medicaid, commercial, self-pay, and charity).
Results: Black men were 4.6% less likely to receive DES compared to white men (80% vs. 84%) [p<0.0001; RR=0.96, 95% CI 0.93– 0.98]. Among self-pay patients, black men were 12.6% less likely to receive DES than white men (p<0.0001). Black women were 5% less likely to receive DES compared to white women (81% vs. 86%) [p<0.0001; RR=0.95, 95% CI 0.93– 0.98]. Sub-group analysis showed significant black-white differences among female charity patients (p=0.0028) and Medicare patients (p=0.008). Charity-paid black women were 26.3% less likely to receive DES than charity-paid white women. Compared with whites, Hispanic men were 4.1% more likely to get DES (88% vs. 84%) [p<0.0001; RR=1.04, 95% CI 1.03–1.05], and Hispanic women were 3.8% more likely to get DES (89% vs. 86%) [p=0.0005; RR=1.04, 95% CI 1.02–1.06].
Conclusion: Overall, among AMI patients who received a stent during PCI, the use of DES was high (84.8%). We found that blacks were slightly less likely to receive DES than whites, who in turn were slightly less likely to receive DES than Hispanics. The Black-white disparity was more pronounced among male self-pay patients and among female charity patients. Research suggests that blacks are at higher risk for restenosis, and they were least likely to receive DES in this study. Insurance status appears to partially explain these results.
This research has received full or partial funding support from the American Heart Association, Greater Southeast Affiliate (Alabama, Florida, Georgia, Louisiana, Mississippi, Puerto Rico & Tennessee).