Racial and Ethnic Disparities Limit Access to PCI for STEMI Patients
CLINICAL QUESTION: At which point(s) of the hospital care process are racial and ethnic disparities most pronounced for patients presenting with ST-segment myocardial infarction (STEMI), where percutaneous coronary intervention (PCI) would be indicated?
BACKGROUND: PCI has significantly reduced mortality in STEMI patients. However, prior research shows that non-Hispanic Black and Hispanic patients with STEMI are less likely to receive standard of care PCI and more likely to die compared to white patients. Research has been limited in detailing when and where along the hospital care pathway these disparities are most present to guide policy intervention.
STUDY DESIGN: Cross-sectional observational study
SETTING: Single state databases (Florida) were queried for all adult emergency department visits with a primary diagnosis of STEMI from January 1, 2011, to December 31, 2021
SYNOPSIS: Researchers evaluated four key care steps: (1) presentation to a PCI-capable hospital, (2) receipt of PCI at the presenting hospital, (3) transfer from a non–PCI-capable hospital, and (4) receipt of PCI after transfer to a PCI-capable hospital. A total of 139,629 patients with a diagnosis of STEMI were included in the evaluation. After adjustment for co-variants and statistical analysis, Black and Hispanic patients were found to be less likely than white patients to present to PCI-capable hospitals (–1.8 and –3.1 percentage points [pp], respectively) and be transferred when needed (–4.0 pp Black, –4.2 pp Hispanic). Additionally, Black patients received less PCI when eligible (–8.6 pp) and were less likely to receive PCI after transfer (–13.3 pp). Study limitations include the use of single-state data, which may limit generalizability, as well as the lack of clinical severity and symptomatic data due to limitations of the dataset.
BOTTOM LINE: Racial and ethnic disparities exist at every stage of STEMI care. Policy interventions are needed to target both hospital access and in-hospital decision-making processes to reduce inequity and mitigate such disparities.
CITATION: Hsuan C, et al. Disparities by race and ethnicity in percutaneous coronary intervention. JAMA Netw Open. 2025;8(9):e2532660. doi: 10.1001/jamanetworkopen.2025.32660.
Dr. Vissepo is an assistant professor of medicine and academic hospitalist at New York Presbyterian-Columbia University Irving Medical Center in New York.