Abstract：
Systems of care have been developed across the United States to standardize care processes and improve outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). The effect of contemporary STEMI systems of care on racial and ethnic disparities in achievement of time-to-treatment goals and mortality in STEMI is uncertain.
We analyzed 178 062 patients with STEMI (52 293 women and 125 769 men) enrolled in the American Heart Association Get With The Guidelines-Coronary Artery Disease registry between January 1, 2015, and December 31, 2021. Patients were stratified into and outcomes compared among 3 racial and ethnic groups: non-Hispanic White, Hispanic White, and Black. The primary outcomes were the proportions of patients achieving the following STEMI process metrics: prehospital ECG obtained by emergency medical services; hospital arrival to ECG obtained within 10 minutes for patients not transported by emergency medical services; arrival-to-percutaneous coronary intervention time within 90 minutes; and first medical contact-to-device time within 90 minutes. A secondary outcome was in-hospital mortality. Analyses were performed separately in women and men, and all outcomes were adjusted for age, comorbidities, acuity of presentation, insurance status, and socioeconomic status measured by social vulnerability index based on patients\' county of residence.
Compared with non-Hispanic White patients with STEMI, Hispanic White patients and Black patients had lower odds of receiving a prehospital ECG and achieving targets for door-to-ECG, door-to-device, and first medical contact-to-device times. These racial disparities in treatment goals were observed in both women and men, and persisted in most cases after multivariable adjustment. Compared with non-Hispanic White women, Hispanic White women had higher adjusted in-hospital mortality (odds ratio, 1.39 [95% CI, 1.12-1.72]), whereas Black women did not (odds ratio, 0.88 [95% CI, 0.74-1.03]). Compared with non-Hispanic White men, adjusted in-hospital mortality was similar in Hispanic White men (odds ratio, 0.99 [95% CI, 0.82-1.18]) and Black men (odds ratio, 0.96 [95% CI, 0.85-1.09]).
Race- or ethnicity-based disparities persist in STEMI process metrics in both women and men, and mortality differences are observed in Hispanic White compared with non-Hispanic White women. Further research is essential to evolve systems of care to mitigate racial differences in STEMI outcomes.
We analyzed 178 062 patients with STEMI (52 293 women and 125 769 men) enrolled in the American Heart Association Get With The Guidelines-Coronary Artery Disease registry between January 1, 2015, and December 31, 2021. Patients were stratified into and outcomes compared among 3 racial and ethnic groups: non-Hispanic White, Hispanic White, and Black. The primary outcomes were the proportions of patients achieving the following STEMI process metrics: prehospital ECG obtained by emergency medical services; hospital arrival to ECG obtained within 10 minutes for patients not transported by emergency medical services; arrival-to-percutaneous coronary intervention time within 90 minutes; and first medical contact-to-device time within 90 minutes. A secondary outcome was in-hospital mortality. Analyses were performed separately in women and men, and all outcomes were adjusted for age, comorbidities, acuity of presentation, insurance status, and socioeconomic status measured by social vulnerability index based on patients\' county of residence.
Compared with non-Hispanic White patients with STEMI, Hispanic White patients and Black patients had lower odds of receiving a prehospital ECG and achieving targets for door-to-ECG, door-to-device, and first medical contact-to-device times. These racial disparities in treatment goals were observed in both women and men, and persisted in most cases after multivariable adjustment. Compared with non-Hispanic White women, Hispanic White women had higher adjusted in-hospital mortality (odds ratio, 1.39 [95% CI, 1.12-1.72]), whereas Black women did not (odds ratio, 0.88 [95% CI, 0.74-1.03]). Compared with non-Hispanic White men, adjusted in-hospital mortality was similar in Hispanic White men (odds ratio, 0.99 [95% CI, 0.82-1.18]) and Black men (odds ratio, 0.96 [95% CI, 0.85-1.09]).
Race- or ethnicity-based disparities persist in STEMI process metrics in both women and men, and mortality differences are observed in Hispanic White compared with non-Hispanic White women. Further research is essential to evolve systems of care to mitigate racial differences in STEMI outcomes.
摘要：
背景：美国已经开发了护理系统，以标准化护理流程并改善ST段抬高型心肌梗死（STEMI）患者的预后。当代STEMI护理系统对实现STEMI治疗时间目标和死亡率的种族和族裔差异的影响尚不确定。
方法：我们分析了在2015年1月1日至2021年12月31日美国心脏协会GetWithTheGuidelines-冠状动脉疾病注册登记的178062例STEMI患者（52293例女性和125769例男性）。患者被分层，并在3个种族和族裔群体中比较结果：非西班牙裔白人，西班牙裔白人,和黑色。主要结果是达到以下STEMI过程指标的患者比例：急诊医疗服务获得的院前心电图；未通过急诊医疗服务运送的患者在10分钟内获得的医院到达心电图；90分钟内到达经皮冠状动脉介入治疗时间；90分钟内首次医疗接触设备时间。次要结果是住院死亡率。分别对女性和男性进行分析，所有结果都根据年龄进行了调整，合并症,演讲的敏锐度，保险状况,社会经济状况由基于患者居住地县的社会脆弱性指数衡量。
结果：与非西班牙裔白人STEMI患者相比，西班牙裔白人患者和黑人患者接受院前心电图和实现门心电图目标的几率较低，门对设备，和第一次医疗接触到设备的时间。在女性和男性中都观察到了治疗目标的种族差异，并在多变量调整后的大多数情况下持续存在。与非西班牙裔白人女性相比，西班牙裔白人女性住院死亡率较高(优势比，1.39[95%CI，1.12-1.72])，而黑人女性没有(赔率比，0.88[95%CI，0.74-1.03]）。与非西班牙裔白人相比，西班牙裔白人男性的调整后住院死亡率相似(比值比，0.99[95%CI，0.82-1.18])和黑人男性(赔率比，0.96[95%CI，0.85-1.09]）。
结论：男性和女性的STEMI过程指标存在种族或种族差异，与非西班牙裔白人女性相比，西班牙裔白人女性的死亡率存在差异。进一步的研究对于发展护理系统以减轻STEMI结果的种族差异至关重要。
方法：我们分析了在2015年1月1日至2021年12月31日美国心脏协会GetWithTheGuidelines-冠状动脉疾病注册登记的178062例STEMI患者（52293例女性和125769例男性）。患者被分层，并在3个种族和族裔群体中比较结果：非西班牙裔白人，西班牙裔白人,和黑色。主要结果是达到以下STEMI过程指标的患者比例：急诊医疗服务获得的院前心电图；未通过急诊医疗服务运送的患者在10分钟内获得的医院到达心电图；90分钟内到达经皮冠状动脉介入治疗时间；90分钟内首次医疗接触设备时间。次要结果是住院死亡率。分别对女性和男性进行分析，所有结果都根据年龄进行了调整，合并症,演讲的敏锐度，保险状况,社会经济状况由基于患者居住地县的社会脆弱性指数衡量。
结果：与非西班牙裔白人STEMI患者相比，西班牙裔白人患者和黑人患者接受院前心电图和实现门心电图目标的几率较低，门对设备，和第一次医疗接触到设备的时间。在女性和男性中都观察到了治疗目标的种族差异，并在多变量调整后的大多数情况下持续存在。与非西班牙裔白人女性相比，西班牙裔白人女性住院死亡率较高(优势比，1.39[95%CI，1.12-1.72])，而黑人女性没有(赔率比，0.88[95%CI，0.74-1.03]）。与非西班牙裔白人相比，西班牙裔白人男性的调整后住院死亡率相似(比值比，0.99[95%CI，0.82-1.18])和黑人男性(赔率比，0.96[95%CI，0.85-1.09]）。
结论：男性和女性的STEMI过程指标存在种族或种族差异，与非西班牙裔白人女性相比，西班牙裔白人女性的死亡率存在差异。进一步的研究对于发展护理系统以减轻STEMI结果的种族差异至关重要。
