Abstract 13425: Low Income Patients With Myocardial Infarction Are Less Likely to Receive a Drug Eluting Stent Than Patients From High Income Areas
Introduction: Choosing a bare metal stent (BMS) vs a drug eluting stent (DES) during STEMI intervention is an important and complex decision that must be made quickly. The on-call physician who is often unfamiliar with the patient (pt) must incorporate both qualitative and quantitative medical factors, as well as estimate the pt's ability to adhere to a prolonged dual antiplatelet strategy. We examined disparities between device allocation (BMS vs DES) and pt socio-demographic factors in a diverse population treated at an urban hospital.
Hypothesis: Patient socioeconomic status is an influential factor in stent selection during STEMI.
Methods: Records from 332 consecutive pts undergoing percutaneous coronary intervention for STEMI were retrospectively reviewed. Demographic data included: age, gender, ZIP code, stent type, self-identified race, and health insurance status. Logistical regression models were used to identify significant co-variables.
Results: The mean age was 55.5 yrs (42% African American (AA), 45% White (W), 13% other). Of the 332 pts, 176 (53%) received BMS and 140 (42%) received DES; and 49% of W pts received DES vs 33% AA (adj OR 0.74, CI 0.41-1.31). Using 2010 U.S. Census Bureau data, median household income (inc) was estimated using home ZIP code (range $21,633-$214,219), and pts were then stratified into inc quartiles. Compared to the highest inc quartile, pts in the lowest quartile were more likely to be AA (72% vs 20%, p<0.0001) and female (34% vs 16%, p=0.01). Nearly all patients were insured (93%), with no differences among inc groups. Strikingly, pts residing in the highest inc quartile were significantly more likely to receive a DES than those residing in the lowest inc quartile (57% vs 33%, adj. OR 2.67, 95% CI 1.27-5.63, p=0.004). The impact of inc on stent choice was strongest with AA (adj. OR 4.37, 95% CI 1.20-15.93, p=0.008), compared to W (adj. OR 1.15, 95% CI 0.34-3.92, p=0.32). Gender, age, and insurance status did not influence stent choice.
Conclusions: DES were less frequently implanted in STEMI pts residing in low inc areas, suggesting that quickly made, non-quantitative, socioeconomic assessments may have important ramifications in stent selection. The fact that this effect was primarily seen in AA pts warrants further evaluation.
Author Disclosures: W. Fiser: None. R. Mazhari: None. C. Nagy: None. H. Young: None. J. Reiner: None.
- © 2015 by American Heart Association, Inc.