Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
Brown University Center for Primary Care & Prevention, Care New England Medical Group/Primary Care & Specialty Services, Pawtucket, RI.
Am Heart J. 2022 Apr;246:82-92. doi: 10.1016/j.ahj.2021.12.013. Epub 2022 Jan 6.
Historically, race, income, and gender were associated with likelihood of receipt of coronary revascularization for acute myocardial infarction (AMI). Given public health initiatives such as Healthy People 2010, it is unclear whether race and income remain associated with the likelihood of coronary revascularization among women with AMI.
Using the Women's Health Initiative Study, hazards ratio (HR) of revascularization for AMI was compared for Black and Hispanic women vs White women and among women with annual income <$20,000/year vs ≥$20,000/year over median 9.5 years follow-up(1993-2019). Proportional hazards models were adjusted for demographics, comorbidities, and AMI type. Results were stratified by revascularization type: percutaneous coronary intervention and coronary artery bypass grafting(CABG). Trends by race and income were compared pre- and post-2010 using time-varying analysis.
Among 5,284 individuals with AMI (9.5% Black, 2.8% Hispanic, and 87.7% White; 23.2% <$20,000/year), Black race was associated with lower likelihood of receiving revascularization for AMI compared to White race in fully adjusted analyses [HR:0.79(95% Confidence Interval:[CI]0.66,0.95)]. When further stratified by type of revascularization, Black race was associated with lower likelihood of percutaneous coronary intervention for AMI compared to White race [HR:0.72(95% CI:0.59,0.90)] but not for CABG [HR:0.97(95%CI:0.72,1.32)]. Income was associated with lower likelihood of revascularization [HR:0.90(95%CI:0.82,0.99)] for AMI. No differences were observed for other racial/ethnic groups. Time periods (pre/post-2010) were not associated with change in revascularization rates.
Black race and income remain associated with lower likelihood of revascularization among patients presenting with AMI. There is a substantial need to disrupt the mechanisms contributing to race, sex, and income disparities in AMI management.
历史上，种族、收入和性别与急性心肌梗死（AMI）患者接受冠状动脉血运重建的可能性相关。鉴于“健康人 2010 年”等公共卫生倡议，目前尚不清楚种族和收入是否仍然与 AMI 女性患者接受冠状动脉血运重建的可能性相关。
利用妇女健康倡议研究，比较了黑人及西班牙裔女性与白人女性、年收入<$20,000/年与≥$20,000/年的女性在中位随访 9.5 年（1993-2019 年）期间因 AMI 接受血运重建的风险比（HR）。多变量比例风险模型调整了人口统计学、合并症和 AMI 类型。结果根据血运重建类型（经皮冠状动脉介入治疗和冠状动脉旁路移植术）进行分层。通过时间变化分析比较了 2010 年前后种族和收入的趋势。
在 5284 名 AMI 患者中（9.5%为黑人、2.8%为西班牙裔、87.7%为白人；23.2%<$20,000/年），与白人女性相比，黑人女性接受 AMI 血运重建的可能性较低（完全调整分析 HR：0.79[95%置信区间：0.66，0.95]）。进一步按血运重建类型分层后，黑人女性接受 AMI 经皮冠状动脉介入治疗的可能性低于白人女性（HR：0.72[95%CI：0.59，0.90]），但接受冠状动脉旁路移植术的可能性没有差异（HR：0.97[95%CI：0.72，1.32]）。收入与 AMI 患者血运重建的可能性较低相关（HR：0.90[95%CI：0.82，0.99]）。其他种族/民族群体未观察到差异。时间阶段（2010 年前/后）与血运重建率的变化无关。
在出现 AMI 的患者中，黑人和收入仍然与血运重建的可能性较低相关。需要大力打破导致 AMI 管理中种族、性别和收入差异的机制。
