Abstract 20395: Racial/Ethnic and Gender Disparities in Use of Drug-Eluting vs. Bare Metal Stents in ST-Elevation Myocardial Infarction Patients, 2006-2012
Background: Recent evidence continues to show the benefit of drug-eluting stents (DES) over bare metal stents (BMS) in patient outcomes following ST-elevation myocardial infarction (STEMI), although the use of DES may be contraindicated in patients with specific comorbidities. In this study, we investigated racial/ethnic and gender disparities in the use of DES, after controlling for the effects of age, insurance status, secular trends, and comorbidities.
Methods: The study population included all STEMI patients (n=60,218) who received PCI and at least one stent in any Florida acute-care hospital during 2006-2012. Hospital discharge data were analyzed. Procedure codes identified DES (ICD-9-CM 36.07) and BMS (ICD-9-CM 36.06). We used logistic regression to model the odds of receiving a DES. Potential predictors included in the model were patient age, racial/ethnic-gender group (referent=White men), year, payer (referent=commercial), diabetes, atrial fibrillation (AFIB), chronic kidney disease (CKD), and end-stage renal disease (ESRD).
Results: Among all STEMI patients, Hispanic women were most likely to receive a DES (61.2%) and Black men were least likely (46.8%). Furthermore, the % of patients who received no stent also varied from 6.7% among Hispanic men to 12.8% among Black women. Multivariable logistic regression results were highly significant, with included independent variables significantly predictive of the odds of receiving a DES in the expected directions. After adjustment and compared with White men, Hispanic women were 24% more likely to receive a DES (OR 1.24, 95%CI 1.13-1.37), White women were 8% more likely to receive a DES (p=0.001), and Black women were 15% less likely to receive a DES (OR 0.85, 95% CI 0.76-0.95). There were no significant differences in DES usage for Hispanic men or for men or women or “other” race/ethnicity. The strongest disparity was observed for Black men, who were 32% less likely to receive a DES than White men (OR 0.68, 95% CI 0.63-0.74, p<0.0001).
Conclusions: In this real-world analysis of unselected and recent STEMI patients, a significant disparity in use of DES for Black men and women was observed. This disparity was not explained by patient age, payer or comorbidities, nor by the secular trend.
Author Disclosures: J.L. Salemi: None. A.P. Pathak: None. E.B. Pathak: None.
- © 2014 by American Heart Association, Inc.