Racial Differences in Acute MI Care

Although multiple studies have shown racial differences in quality of care for acute coronary syndromes, few have explored this phenomenon in hospitals without coronary revascularization services. In a new study, investigators analyzed data from 1,215,924 black and white Medicare beneficiaries 68 years or older with acute MI (AMI) who were admitted to any of 4627 U.S. hospitals. Of these hospitals, 3488 did not offer full revascularization services.

Among patients admitted to hospitals without revascularization services, black patients were significantly less likely than white patients to be transferred elsewhere for revascularization, either within 2 days (7% vs. 12%) or within 30 days (25% vs. 31%) of admission. Whether or not they were admitted to hospitals with revascularization services, black patients were less likely to receive revascularization than were white patients (34% vs. 50% admitted to hospitals with services, and 18% vs. 26% admitted to hospitals without services). Even when they were transferred to hospitals with revascularization services, black patients remained significantly less likely than white patients to undergo revascularization. Although black patients had lower 30-day mortality rates than did white patients, they had significantly higher longer-term mortality rates.