美国亚裔族群的心肌梗死治疗质量与结局。
Myocardial Infarction Quality of Care and Outcomes in Asian Ethnic Groups in the United States.
机构信息
Department of Medicine (A.V., X.H., N.R.K., D.M.L.-J., S.S.K., N.S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Internal Medicine, Washington University School of Medicine in St. Louis, MO (A.V., M.D.H.).
出版信息
Circ Cardiovasc Qual Outcomes. 2024 Oct;17(10):e011097. doi: 10.1161/CIRCOUTCOMES.124.011097. Epub 2024 Sep 10.
BACKGROUND
National-level differences in myocardial infarction (MI) quality of care among Asian patients in the United States are unclear. We assessed the quality of MI care in the 6 largest US Asian ethnic groups.
METHODS
Patients aged ≥18 years with ST-segment-elevation MI or non-ST-segment-elevation MI in the Get With The Guidelines-Coronary Artery Disease registry (711 US hospitals, 2015-2021) were assessed. The odds of MI-related quality of care and process outcomes were evaluated in Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and other Asian adults compared with non-Hispanic White adults. Sex-stratified logistic regression models were adjusted for age and clinical characteristics.
RESULTS
There were 5691 Asian patients (1520 Asian Indian, 422 Chinese, 430 Filipino, 114 Japanese, 283 Korean, 553 Vietnamese, and 2369 other Asian) and 141 271 non-Hispanic White patients, overall 30% female, and mean age of 66.5 years. Relative to non-Hispanic White adults, among patients with ST-segment-elevation MI, door-to-ECG time ≤10 minutes was less likely in Asian Indian (adjusted odds ratio [aOR], 0.64 [95% CI, 0.50-0.82]), Chinese (aOR, 0.65 [95% CI, 0.46-0.93]), and Korean (aOR, 0.57 [95% CI, 0.33-0.97]) men and in other Asian women (aOR, 0.61 [95% CI, 0.41-0.90]). Door-to-balloon time ≤90 minutes was less likely in Asian Indian men (aOR, 0.71 [95% CI, 0.56-0.90]) and Filipina women (aOR, 0.48 [95% CI, 0.24-0.98]). In patients with ST-segment-elevation MI or non-ST-segment-elevation MI, optimal medical therapy for MI was less likely in Korean men (aOR, 0.65 [95% CI, 0.47-0.90]) and more likely in Asian Indian men (aOR, 1.22 [95% CI, 1.06-1.40]) and women (aOR, 1.32 [95% CI, 1.04-1.67]) and Filipina women (aOR, 1.84 [95% CI, 1.27-2.67]).
CONCLUSIONS
MI quality of care varies among US Asian patients with ST-segment-elevation MI and non-ST-segment-elevation MI. Quality improvement programs must identify and address the factors that result in suboptimal MI quality of care among US Asian patients.
背景
美国亚洲患者心肌梗死（MI）护理质量在国家层面上存在差异尚不清楚。我们评估了美国 6 个最大的亚洲族群的 MI 护理质量。
方法
在 Get With The Guidelines-Coronary Artery Disease 注册中心（711 家美国医院，2015-2021 年）中，评估了年龄≥18 岁的 ST 段抬高型 MI 或非 ST 段抬高型 MI 患者。与非西班牙裔白人成年人相比，评估了印度裔、华裔、菲律宾裔、日裔、韩裔、越裔和其他亚洲成年人的 MI 相关护理质量和治疗结果的可能性。采用分层逻辑回归模型，根据年龄和临床特征进行调整。
结果
共有 5691 名亚洲患者（1520 名印度裔、422 名华裔、430 名菲律宾裔、114 名日裔、283 名韩裔、553 名越裔和 2369 名其他亚洲人）和 141271 名非西班牙裔白人患者，总体女性占 30%，平均年龄为 66.5 岁。与非西班牙裔白人成年人相比，在 ST 段抬高型 MI 患者中，门到心电图时间≤10 分钟的可能性较小：印度裔男性（校正比值比[OR]，0.64[95%置信区间，0.50-0.82]）、华裔男性（OR，0.65[95%置信区间，0.46-0.93]）和韩裔男性（OR，0.57[95%置信区间，0.33-0.97]），以及其他亚洲女性（OR，0.61[95%置信区间，0.41-0.90]）。门到球囊时间≤90 分钟的可能性较小：印度裔男性（OR，0.71[95%置信区间，0.56-0.90]）和菲律宾裔女性（OR，0.48[95%置信区间，0.24-0.98]）。在 ST 段抬高型 MI 或非 ST 段抬高型 MI 患者中，接受 MI 最佳药物治疗的可能性较小：韩裔男性（OR，0.65[95%置信区间，0.47-0.90]）和印度裔男性（OR，1.22[95%置信区间，1.06-1.40]）和女性（OR，1.32[95%置信区间，1.04-1.67]）以及菲律宾裔女性（OR，1.84[95%置信区间，1.27-2.67]）。
结论
美国 ST 段抬高型 MI 和非 ST 段抬高型 MI 亚洲患者的 MI 护理质量存在差异。质量改进计划必须确定并解决导致美国亚洲患者 MI 护理质量不理想的因素。
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