Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA.
Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK.
Curr Probl Cardiol. 2023 Sep;48(9):101798. doi: 10.1016/j.cpcardiol.2023.101798. Epub 2023 May 11.
This study assessed the COVID-19 pandemic's impact on racial disparities in acute myocardial infarction (AMI) management and outcomes. We reviewed AMI patient management and outcomes in the pandemic's initial nine months, comparing COVID-19 and non-COVID-19 cases using 2020's National Inpatient Sample data. Our findings revealed that patients with concurrent AMI and COVID-19 had higher in-hospital mortality (aOR 3.19, 95% CI 2.63-3.88), increased mechanical ventilation (aOR 1.90, 95% CI 1.54-2.33), and higher initiation of hemodialysis (aOR 1.38, 95% CI 1.05-1.89) compared to those without COVID-19. Moreover, Black and Asian/Pacific Islander patients had higher in-hospital mortality than White patients, (aOR 2.13, 95% CI 1.35-3.59; aOR 3.41, 95% CI 1.5-8.37). Also, Black, Hispanic, and Asian/Pacific Islander patients showed higher odds of initiating hemodialysis (aOR 5.48, 95% CI 2.13-14.1; aOR 2.99, 95% CI 1.13-7.97; aOR 7.84, 95% CI 1.55-39.5), and were less likely to receive PCI for AMI (aOR 0.71, 95% CI 0.67-0.74; aOR 0.81, 95% CI 0.77-0.86; aOR 0.82, 95% CI 0.75-0.90). Black patients also showed less likelihood of undergoing CABG (aOR 0.55, 95% CI 0.49-0.61). Our study highlights elevated mortality and complications in COVID-19 AMI patients, emphasizing significant racial disparities. These findings underscore the pressing need for initiatives addressing healthcare disparities, enhancing access, and promoting culturally sensitive care to boost health equity.
本研究评估了 COVID-19 大流行对急性心肌梗死(AMI)管理和结局中种族差异的影响。我们回顾了大流行最初九个月的 AMI 患者管理和结局,使用 2020 年全国住院患者样本数据比较了 COVID-19 和非 COVID-19 病例。我们的研究结果表明,同时患有 AMI 和 COVID-19 的患者住院死亡率更高(aOR 3.19,95%CI 2.63-3.88),机械通气的使用更多(aOR 1.90,95%CI 1.54-2.33),开始血液透析的比例更高(aOR 1.38,95%CI 1.05-1.89),与没有 COVID-19 的患者相比。此外,与白人患者相比,黑人患者和亚太裔患者的住院死亡率更高(aOR 2.13,95%CI 1.35-3.59;aOR 3.41,95%CI 1.5-8.37)。此外,黑人、西班牙裔和亚太裔患者开始血液透析的可能性更高(aOR 5.48,95%CI 2.13-14.1;aOR 2.99,95%CI 1.13-7.97;aOR 7.84,95%CI 1.55-39.5),接受 AMI 经皮冠状动脉介入治疗(PCI)的可能性更小(aOR 0.71,95%CI 0.67-0.74;aOR 0.81,95%CI 0.77-0.86;aOR 0.82,95%CI 0.75-0.90)。黑人患者行冠状动脉旁路移植术(CABG)的可能性也较小(aOR 0.55,95%CI 0.49-0.61)。我们的研究强调了 COVID-19 合并 AMI 患者死亡率和并发症升高,凸显了显著的种族差异。这些发现突显了需要采取举措解决医疗保健差异,增加获取途径,并促进文化敏感护理,以提高健康公平性。