Saadiq M Moledina1, Ahmad Shoaib1, Clive Weston2, Suleman Aktaa3,4,5, Harriette G C Van Spall6, Aliya Kassam7, Evangelos Kontopantelis8, Shrilla Banerjee9, Muhammad Rashid1, Chris P Gale3,4,5, Mamas A Mamas1. 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK. 2. Glangwili General Hospital, Carmarthen, Wales, UK. 3. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. 4. Leeds Institute for Data Analytics, University of Leeds, Leeds, UK. 5. Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 6. Department of Medicine, McMaster University, Hamilton, Population Health Research Institute, Hamilton and ICES, Hamilton, Canada. 7. Department of Community Health Sciences, University of Calgary, Canada. 8. Division of Informatics, Imaging and Data Sciences, University of Manchester, UK. 9. Department of Cardiology, Surrey and Sussex Healthcare, NHS Trust, UK.
Abstract
AIMS: Little is known about ethnic disparities in care and clinical outcomes of patients admitted with non-ST-segment elevation myocardial infarction (NSTEMI) in national cohorts from universal healthcare systems derived from Europe. METHODS AND RESULTS: We identified 280 588 admissions with NSTEMI in the UK Myocardial Infarction National Audit Project (MINAP), 2010-2017, including White patients (n = 258 364) and Black, Asian, and Minority Ethnic (BAME) patients (n = 22 194). BAME patients were younger (66 years vs. 73 years, P < 0.001) and more frequently had hypertension (66% vs. 54%, P < 0.001), hypercholesterolaemia (49% vs. 34%, P < 0.001), and diabetes (48% vs. 24%, P < 0.001). BAME patients more frequently received invasive coronary angiography (80% vs. 68%, P < 0.001), percutaneous coronary intervention (PCI) (52% vs. 43%, P < 0.001), and coronary artery bypass graft surgery (9% vs. 7%, P < 0.001). Following propensity score matching, BAME compared with White patients had similar in-hospital all-cause mortality [odds ratio (OR) 0.91, confidence interval (CI) 0.76-1.06; P = 0.23], major bleeding (OR 0.99, CI 0.75-1.25; P = 0.95), re-infarction (OR 1.15, CI 0.84-1.46; P = 0.34), and major adverse cardiovascular events (MACE) (OR 0.94, CI 0.80-1.07; P = 0.35). CONCLUSION: BAME patients with NSTEMI had higher cardiometabolic risk profiles and were more likely to undergo invasive angiography and revascularization, with similar clinical outcomes as those of their White counterparts. Among the quality indicators assessed, there is no evidence of care disparities among BAME patients presenting with NSTEMI. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Little is known about ethnic disparities in care and clinical outcomes of patients admitted with non-ST-segment elevation myocardial infarction (NSTEMI) in national cohorts from universal healthcare systems derived from Europe. METHODS AND RESULTS: We identified 280 588 admissions with NSTEMI in the UK Myocardial Infarction National Audit Project (MINAP), 2010-2017, including White patients (n = 258 364) and Black, Asian, and Minority Ethnic (BAME) patients (n = 22 194). BAME patients were younger (66 years vs. 73 years, P < 0.001) and more frequently had hypertension (66% vs. 54%, P < 0.001), hypercholesterolaemia (49% vs. 34%, P < 0.001), and diabetes (48% vs. 24%, P < 0.001). BAME patients more frequently received invasive coronary angiography (80% vs. 68%, P < 0.001), percutaneous coronary intervention (PCI) (52% vs. 43%, P < 0.001), and coronary artery bypass graft surgery (9% vs. 7%, P < 0.001). Following propensity score matching, BAME compared with White patients had similar in-hospital all-cause mortality [odds ratio (OR) 0.91, confidence interval (CI) 0.76-1.06; P = 0.23], major bleeding (OR 0.99, CI 0.75-1.25; P = 0.95), re-infarction (OR 1.15, CI 0.84-1.46; P = 0.34), and major adverse cardiovascular events (MACE) (OR 0.94, CI 0.80-1.07; P = 0.35). CONCLUSION: BAME patients with NSTEMI had higher cardiometabolic risk profiles and were more likely to undergo invasive angiography and revascularization, with similar clinical outcomes as those of their White counterparts. Among the quality indicators assessed, there is no evidence of care disparities among BAME patients presenting with NSTEMI. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Saadiq M Moledina; Ahmad Shoaib; Louise Y Sun; Phyo K Myint; Rafail A Kotronias; Benoy N Shah; Chris P Gale; Hude Quan; Rodrigo Bagur; Mamas A Mamas Journal: Eur Heart J Qual Care Clin Outcomes Date: 2022-09-05
Authors: Mohamed Dafaalla; Muhammad Rashid; Rachel M Bond; Triston Smith; Purvi Parwani; Ritu Thamman; Saadiq M Moledina; Michelle M Graham; Mamas A Mamas Journal: CJC Open Date: 2021-10-02