Racial disparities in the management of non ST-segment elevation myocardial infarction (NSTEMI) persist despite narrowing over time, according to results from The Atherosclerosis Risk in Communities (ARIC) Surveillance Study presented Tuesday at Scientific Sessions.
The study looked at trends in angiographic evaluation and revascularization for NSTEMI. Since 1987, the ARIC study has conducted hospital surveillance of acute MI in four U.S. states: Maryland, Minnesota, Missouri and North Carolina. Clinical data and procedures were abstracted from the medical records, and NSTEMI was classified with a validated algorithm.
Study presenter Sameer Arora, MD, and colleagues compared the probabilities of angiography and revascularization for white patients (n=21,721) relative to black patients (n=9,525) with adjustment for age, sex, TIMI risk score and hospital geographic region.
“Invasive strategy (angiography with intent to revascularize) has become the guideline-recommended standard for management of NSTEMI,” said Arora, of the Division of Cardiology at the University of North Carolina School of Medicine in Chapel Hill. “The efficacy of this strategy has been widely accepted, but it appears to be utilized less when patients are black. Racial disparities in angiography and revascularization would have the potential to negatively influence mortality outcomes for black patients.”
In the study, black patients were more often female and younger. From 1987 to 2004, the proportion of patients undergoing angiography and revascularization increased for both black and white patients. Then from 2005 to 2013, it declined. However, data revealed that the proportion of patients evaluated by angiography was higher for white than black patients, reaching a peak disparity in 1992. A higher proportion of white patients was revascularized each year, reaching a peak disparity in 1990.
Many factors may be influencing the trend toward narrowing disparities observed in the study, Arora said. One of the most important may have been the development of NSTEMI guidelines and management algorithms in the late 1990s, he said. Greater access to medical insurance also may have been a factor.
Finally, narrowing racial disparities may have resulted from the expansion of cardiac catheterization units over the past decades, he said. Many of the black patients were sampled from economically depressed regions, which may not have had cardiac catheterization services available at the start of the surveillance.