Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK.
Glangwili General Hospital, Carmarthen, Wales, UK.
Eur Heart J Qual Care Clin Outcomes. 2022 Aug 17;8(5):518-528. doi: 10.1093/ehjqcco/qcab030.
Little is known about ethnic disparities in care and clinical outcomes of patients admitted with non-ST-segment elevation myocardial infarction (NSTEMI) in national cohorts from universal healthcare systems derived from Europe.
We identified 280 588 admissions with NSTEMI in the UK Myocardial Infarction National Audit Project (MINAP), 2010-2017, including White patients (n = 258 364) and Black, Asian, and Minority Ethnic (BAME) patients (n = 22 194). BAME patients were younger (66 years vs. 73 years, P < 0.001) and more frequently had hypertension (66% vs. 54%, P < 0.001), hypercholesterolaemia (49% vs. 34%, P < 0.001), and diabetes (48% vs. 24%, P < 0.001). BAME patients more frequently received invasive coronary angiography (80% vs. 68%, P < 0.001), percutaneous coronary intervention (PCI) (52% vs. 43%, P < 0.001), and coronary artery bypass graft surgery (9% vs. 7%, P < 0.001). Following propensity score matching, BAME compared with White patients had similar in-hospital all-cause mortality [odds ratio (OR) 0.91, confidence interval (CI) 0.76-1.06; P = 0.23], major bleeding (OR 0.99, CI 0.75-1.25; P = 0.95), re-infarction (OR 1.15, CI 0.84-1.46; P = 0.34), and major adverse cardiovascular events (MACE) (OR 0.94, CI 0.80-1.07; P = 0.35).
BAME patients with NSTEMI had higher cardiometabolic risk profiles and were more likely to undergo invasive angiography and revascularization, with similar clinical outcomes as those of their White counterparts. Among the quality indicators assessed, there is no evidence of care disparities among BAME patients presenting with NSTEMI.
在来自欧洲全民医疗保健系统的国家队列中，对于因非 ST 段抬高型心肌梗死（NSTEMI）住院的患者，有关其护理和临床结局的种族差异知之甚少。
我们在英国心肌梗死国家审计项目（MINAP）中确定了 2010 年至 2017 年 280588 例 NSTEMI 住院患者，包括白人患者（n=258364）和黑人、亚洲及少数民族（BAME）患者（n=22194）。BAME 患者更年轻（66 岁 vs. 73 岁，P<0.001），且更常患有高血压（66% vs. 54%，P<0.001）、高胆固醇血症（49% vs. 34%，P<0.001）和糖尿病（48% vs. 24%，P<0.001）。BAME 患者更常接受有创冠状动脉造影（80% vs. 68%，P<0.001）、经皮冠状动脉介入治疗（PCI）（52% vs. 43%，P<0.001）和冠状动脉旁路移植术（9% vs. 7%，P<0.001）。在进行倾向评分匹配后，与白人患者相比，BAME 患者的院内全因死亡率相似[比值比（OR）0.91，置信区间（CI）0.76-1.06；P=0.23]，大出血（OR 0.99，CI 0.75-1.25；P=0.95）、再梗死（OR 1.15，CI 0.84-1.46；P=0.34）和主要不良心血管事件（MACE）（OR 0.94，CI 0.80-1.07；P=0.35）。
患有 NSTEMI 的 BAME 患者存在更高的心血管代谢风险，且更有可能接受有创血管造影和血运重建，其临床结局与白人患者相似。在评估的质量指标中，没有证据表明 BAME 患者因 NSTEMI 就诊存在护理差异。
