Racial disparity in Coronary Artery Stenting and Outcomes Following STEMI

Rizwan, Muhammad

Background
Racial disparities have been well reported in many medical and surgical specialties in the US health care showing non-white patients suffering inferior outcomes as compared to white patients. These disparities have also extended to cardiovascular outcomes. Use of drug eluting stents for coronary artery stenting is after STEMI have been shown to be superior to bare metal stents and has led to shift of drug eluting stent use. Thus, we plan to study the outcomes of coronary artery stenting and type of stent placement after STEMI in white and non-white patients.

Methods
A retrospective analysis of National Inpatient Sample was performed to identify all the patients who underwent coronary artery stenting following STEMI from 2005-2014.Appropriate ICD-9 codes were used to identify procedures and comorbidities. Univariate (Chi Square, t test) and multivariate logistic regression models were employed. Generalized linear model was used to estimate, mortality, length of stay and hospitalization cost.

Results
Out of total coronary artery stents placed 515,212 following STEMI, 140,500 were Bare Metal Stents (BMS) and 374,712 were Drug Eluting Stents (DES). After adjusting the patients without marked race in the data BMS were 117,344 and DES were 312,122. In white population 90,749 BMS as compared to 11,198 in blacks and 15,397 in other races with p value<0.001. DES were 244,748 in white population as compared to the 24,054 in black and 43,320 in other races with p value < 0.001. The odds ratio of DES in black population when compared to the white population was 0.84, z = -13.54 and C.I. 0.82 to 0.86. Mortality in white population with BMS was 3984 (4.39 %) and DES was 4,549 (1.86 %) with p value <0.001. Mortality in Black population with BMS was 380 (3.39 %) and DES 421 (1.75 %) p value <0.001. Mortality in other races with BMS was 687 (4.46 %) and DES (2.19 %) with p-value <0.001.

Conclusions
This study shows that African-American patients are less likely to receive DES as compared to white patients. Mortality was high in BMS as compared to the DES and cost of hospitalization was more in DES. DES were more likely to be placed in the urban areas as compared to the rural areas.