title: Race and Sex Differences in Management and Outcomes of Patients After ST-Elevation and Non-ST-Elevation Myocardial Infarct: Results From the NCDR.
abstract: BACKGROUND
  Race and sex have been shown to affect management of myocardial infarction (MI); however, it is unclear if such disparities exist in contemporary care of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI).
  
  
  OBJECTIVE
  Disparities in care will be less prevalent in more heavily protocol-driven management of STEMI than the less algorithmic care of NSTEMI.
  
  
  METHODS
  Data were collected from the ACTION Registry-GWTG database to assess care differences related to race and sex of patients presenting with NSTEMI or STEMI. For key treatments and outcomes, adjustments were made including patient demographics, baseline comorbidities, and markers of socioeconomic status.
  
  
  RESULTS
  Key demographic variables demonstrate significant differences in baseline comorbidities; black patients had higher incidences of hypertension and diabetes, and women more frequently had diabetes. With few exceptions, rates of acute and discharge medical therapy were similar by race in any sex category in both STEMI and NSTEMI populations. Rates of catheterization were similar by race for STEMI but not for NSTEMI, where both black men and women had lower rates of invasive therapy. Rates of revascularization were significantly lower for black patients in both the STEMI and NSTEMI groups regardless of sex. Rates of adverse events differed by sex, with disparities for death and major bleeding; after adjustment, rates were similar by race within sex comparisons.
  
  
  CONCLUSIONS
  In this contemporary cohort, although there are differences by race in presentation and management of MI, heavily protocol-driven processes seem to show fewer racial disparities.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
authors.forename: D
authors.initials: D
authors.lastname: Edmund Anstey
authors.affiliation: Cardiovascular Division, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Shuang
authors.initials: S
authors.lastname: Li
authors.affiliation: Cardiovascular Division, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Cardiovascular Division, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts. swiviott@partners.org.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Wiviott
mesh_terms: D001741:Black or African American; D000368:Aged; D005260:Female; D006302:Health Services Research; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D017064:Process Assessment, Health Care; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People
keywords: Acute coronary syndrome; Disparities in Care; Gender; NSTEMI; Race; STEMI