Equity Gaps in the Diagnosis and Treatment of Occlusion Myocardial Infarction.

BACKGROUND

Patients with occlusion myocardial infarction (OMI) who meet the ST-elevation myocardial infarction (STEMI) criteria experience inequitable delays in care, because of sociodemographic factors, such as age and sex. OMI patients who do not meet STEMI criteria and are admitted to the hospital as non-STEMI patients, experience further delays. However, whether equity gaps exist in OMI care remains unknown.

METHODS

A retrospective chart review included patients with acute coronary syndrome admitted to the hospital through 2 academic emergency departments, in the period from January 1, 2021 to December 31, 2022. Patients were categorized as having one of the following: OMI (acute culprit with Thrombolysis In Myocardial Infarction [TIMI] 0-2 flow, or acute culprit with TIMI 3 flow, and a troponin I level > 10,000 ng/L; or if they had no angiogram, a troponin I level > 10,000 ng/L plus new regional wall-motion abnormality on echocardiogram); non-OMI (MI that did not meet the OMI threshold); or MI ruled out.

RESULTS

Among 662 charts, 260 were OMI patients, 296 were non-OMI patients, and 106 were patients with MI ruled out. Of the 260 OMI patients, 116 were admitted to the hospital as STEMI patients (true-positive), and 144 (55.4%) were admitted as non-STEMI patients (false-negative). In bivariate analyses, true-positive STEMI patients with atypical symptoms had a longer door-to-electrocardiogram (ECG) time ( < 0.0001) and a longer ECG-to-catheterization time ( < 0.001). False-negative STEMI patients had a longer door-to-ECG time for atypical symptoms ( < 0.0001), a longer ECG-to-catheterization time for atypical symptoms ( = 0.003), and were aged ≥75 years ( = 0.006).

CONCLUSIONS

True-positive STEMI patients had delayed ECGs and catheterization for those presenting with atypical symptoms. More than half of those with OMI were admitted as non-STEMI patients, with further reperfusion delays for older patients and those presenting with atypical symptoms. Shifting to the OMI paradigm highlights reperfusion delays and equity gaps in the management of ACS.