Racial Difference in Symptom Onset to Door Time in ST Elevation Myocardial Infarction.
There are poorer outcomes following ST elevation myocardial infarction in blacks compared to white patients despite comparable door-to-reperfusion time. We hypothesized that delays to hospital presentation may be contributory.



We conducted a retrospective analysis of the 1144 patients admitted for STEMI in our institution from 2008 to 2013. The door-to-balloon time (D2BT) and symptom-onset-to-door time (SODT) were compared by race. Bivariate analysis was done comparing the median D2BT and SODT. Stratified analyses were done to evaluate the effect of race on D2BT and SODT, accounting for insurance status, age, sex and comorbidities. The mean age was 59±13 years; 56% of this population was black and 41% was white. Males accounted for 66% of this population. The median D2BT was 60 minutes (interquartile range [IQR] 42-82), and median SODT was 120 minutes (IQR 60-720). There was no significant difference in D2BT by race (P=0.86). Black patients presented to the emergency room (ER) later than whites (SODT=180 [IQR 60-1400] vs 120 [IQR 60-560] minutes, P<0.01) and were more likely to be uninsured (P<0.01). After controlling for comorbidities, insurance, and socioeconomic status, blacks were 60% more likely to present late after a STEMI (OR 1.6, P<0.01). A subset analysis excluding transferred patients showed similar results.



Black patients present later to the ER after STEMI with no difference in D2BT compared to whites. This difference in time to presentation may be one of the factors accounting for poor outcomes in this population.
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Oluwaseyi
O
Bolorunduro
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Blake
B
Smith
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Mason
M
Chumpia
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Poojitha
P
Valasareddy
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Mark R
MR
Heckle
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Rami N
RN
Khouzam
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.
Guy L
GL
Reed
Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN uibebuog@uthsc.edu ibebuogu@gmail.com.
Uzoma N
UN
Ibebuogu
D001741:Black or African American; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D012923:Social Class; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D044465:White People
ST‐segment elevation myocardial infarction; disparities; door‐to‐balloon time; outcome; race and ethnicity
Cancer. 2015 Mar 1;121(5):724-32
25624186
Am J Cardiol. 2014 Apr 15;113(8):1273-9
24576541
JAMA. 2010 Aug 18;304(7):763-71
20716739
Circulation. 2013 Apr 2;127(13):1395-403
23547179
Am J Cardiol. 2008 Oct 1;102(7):802-8
18805101
Am J Cardiol. 2013 Oct 1;112(7):911-7
23768458
BMJ. 2009 May 19;338:b1807
19454739
Circ Cardiovasc Qual Outcomes. 2014 Jan;7(1):86-94
24425697
J Am Coll Cardiol. 2003 Sep 17;42(6):991-7
13678918
Am J Med. 2011 Jan;124(1):48-57
21187185
Clin Cardiol. 2013 Dec;36(12):749-56
24085713
Arch Intern Med. 1999 Oct 11;159(18):2141-7
10527291
Am J Cardiol. 2014 Mar 1;113(5):798-802
24393257
Am J Crit Care. 2000 Jul;9(4):237-44
10888146
Circulation. 2014 Jan 21;129(3):399-410
24446411
JAMA. 2010 Jun 2;303(21):2148-55
20516415
Heart. 2012 Dec;98(23):1738-42
23024005
JAMA. 2000 Jun 14;283(22):2941-7
10865271
Circulation. 2013 Jan 29;127(4):e362-425
23247304