Edmund Anstey D, Li Shuang, Thomas Laine, Wang Tracy Y, Wiviott Stephen D
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
Cardiovascular Division, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
Clin Cardiol. 2016 Oct;39(10):585-595. doi: 10.1002/clc.22570. Epub 2016 Jul 28.
Race and sex have been shown to affect management of myocardial infarction (MI); however, it is unclear if such disparities exist in contemporary care of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI).
Disparities in care will be less prevalent in more heavily protocol-driven management of STEMI than the less algorithmic care of NSTEMI.
Data were collected from the ACTION Registry-GWTG database to assess care differences related to race and sex of patients presenting with NSTEMI or STEMI. For key treatments and outcomes, adjustments were made including patient demographics, baseline comorbidities, and markers of socioeconomic status.
Key demographic variables demonstrate significant differences in baseline comorbidities; black patients had higher incidences of hypertension and diabetes, and women more frequently had diabetes. With few exceptions, rates of acute and discharge medical therapy were similar by race in any sex category in both STEMI and NSTEMI populations. Rates of catheterization were similar by race for STEMI but not for NSTEMI, where both black men and women had lower rates of invasive therapy. Rates of revascularization were significantly lower for black patients in both the STEMI and NSTEMI groups regardless of sex. Rates of adverse events differed by sex, with disparities for death and major bleeding; after adjustment, rates were similar by race within sex comparisons.
In this contemporary cohort, although there are differences by race in presentation and management of MI, heavily protocol-driven processes seem to show fewer racial disparities.
种族和性别已被证明会影响心肌梗死（MI）的治疗；然而，在当代ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）的治疗中，此类差异是否存在尚不清楚。
与NSTEMI较少遵循算法的治疗相比，在更严格遵循方案驱动的STEMI管理中，治疗差异的普遍性会更低。
从ACTION注册研究-GWTG数据库收集数据，以评估与NSTEMI或STEMI患者的种族和性别相关的治疗差异。对于关键治疗和结果，进行了调整，包括患者人口统计学、基线合并症和社会经济地位指标。
关键人口统计学变量显示基线合并症存在显著差异；黑人患者高血压和糖尿病的发病率较高，女性糖尿病的发病率更高。除少数例外，在STEMI和NSTEMI人群中，任何性别类别中急性和出院药物治疗的种族发生率相似。STEMI患者的导管插入率在种族间相似，但NSTEMI患者并非如此，黑人男性和女性的侵入性治疗率均较低。无论性别如何，STEMI和NSTEMI组中黑人患者的血运重建率均显著较低。不良事件发生率因性别而异，在死亡和大出血方面存在差异；调整后，性别内种族比较的发生率相似。
在这个当代队列中，尽管MI的表现和治疗在种族上存在差异，但严格遵循方案驱动的流程似乎显示出较少的种族差异。
