Research Spotlight: Race-Based Differences in ST Elevation Myocardial Infarction (STEMI) Process Metrics

Asishana Osho, MD, MPH, a physician investigator in the Department of Surgery at Mass General and an Assistant Professor of Surgery at Harvard Medical School, is the lead author of a new study in the journal Circulation, Race-Based Differences in ST-Segment–Elevation Myocardial Infarction Process Metrics and Mortality From 2015 Through 2021: An Analysis of 178 062 Patients from the American Heart Association Get With The Guidelines–Coronary Artery Disease Registry

Summary:

In this large registry study including over 175,000 patients presenting acutely with heart attacks, authors demonstrated that individuals of Hispanic & Black race/ethnicity were less likely that those of white race/ethnicity to receive treatment according to well established and nationally used quality metrics for care. These patterns were observed in both men and women and have lasting implications for the design and implementation of systems of cardiovascular care in the future.

What Question Were You Investigating?

We set out to explore demographic differences (race/ethnicity and gender) in the attainment of critical system of care metrics in patients with ST elevation myocardial infarction, a type of heart attack that has a greater risk of serious complications or death.

What Methods or Approach Did You Use?

The study was designed as a retrospective cohort analysis of a large number of patients within a prospectively assembled national database/registry.

We analyzed approximately 178,000 patients (52,000 women and 126,000 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 three racial and ethnic groups—non-Hispanic White, Hispanic White and Black. 

The primary outcomes where the proportion of patients achieving the following metrics:

• Prehospital echocardiogram (ECG) obtained by emergency medical services
• Hospital arrival to ECG within 10 minutes for patients not transported by EMS
• Arrival to percutaneous intervention time within 90 minutes
• First medical contact-to-device time within 90 minutes

A second outcome was in-hospital mortality.

What Were the Results?

Hispanic White or Black patients had lower odds of meeting time-to-diagnosis or treatment goals compared with non-Hispanic White patients.

What are the Clinical Implications?

Important race- or ethnicity-based disparities persist in STEMI systems-of-care metrics and in mortality after STEMI. These racial disparities in treatment goals were observed in both women and men and persisted in most cases after multivariable adjustment.

What Are the Next Steps?

More research is essential for STEMI systems of care to evolve so that race- or ethnicity-based disparities in STEMI outcomes can be mitigated.

Paper Cited:

Osho, A., Fernandes, M. F., Poudel, R., de Lemos, J., Hong, H., Zhao, J., Li, S., Thomas, K., Kikuchi, D. S., Zegre-Hemsey, J., Ibrahim, N., Shah, N. S., Hollowell, L., Tamis-Holland, J., Granger, C. B., Cohen, M., Henry, T., Jacobs, A. K., Jollis, J. G., Yancy, C. W., … Goyal, A. (2023). Race-Based Differences in ST-Segment-Elevation Myocardial Infarction Process Metrics and Mortality From 2015 Through 2021: An Analysis of 178 062 Patients From the American Heart Association Get With The Guidelines-Coronary Artery Disease Registry. Circulation, 148(3), 229–240. https://doi.org/10.1161/CIRCULATIONAHA.123.065512

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.