Racial Disparities Found in Treatment Rates for Patients With ACS and History of Cocaine Use

May 25, 2022—The Society for Cardiovascular Angiography & Interventions (SCAI) announced the presentation of a nationwide study that determined that among those with acute coronary syndrome (ACS) and history of cocaine use, rates of cardiac catheterization or revascularization were significantly lower in non-Hispanic Black patients compared to White patients.

The findings were presented by lead author Michael Dangl, MD, at SCAI’s 2022 Scientific Sessions held May 19-22 in Atlanta, Georgia. The authors are working to complete the final manuscript with Rishi Wadhera, MD, with the Beth Israel Deaconess Medical Center in Boston, Massachusetts.

“We noticed in hospitals in Miami, rates of cardiac catheterization or revascularization, especially among cocaine users, was often a subjective decision based on a variety of factors and wanted to see if this was true on a national scale,” explained Dr. Dangl, a resident at University of Miami in Miami, Florida. “We were motivated by our Internal Medicine Program Director, Dr. Stefanie Brown, and our research mentor, Dr. Rosario Colombo, to develop this research question.”

As noted by the SCAI announcement, cocaine use can cause coronary artery vasospam, leading to myocardial ischemia, ACS, and acute myocardial infarction. American Heart Association guidelines state that patients with a history of cocaine use who are diagnosed with ACS should be treated the same as nonuse patients.

Using data from the National Inpatient Sample Database between 2011 to 2019, researchers compared baseline characteristics and in-hospital outcomes between non-Hispanic Black and White patients who had history of cocaine use and a primary admission diagnosis of ACS to determine whether race was a treatment factor.

Multivariate logistic-regression adjusted for age, sex, ST-segment elevation myocardial infarction, tobacco use, and comorbidities for cardiac catheterization and revascularization.

• Investigators identified 43,798 hospitalizations and found the following:
• 26,905 hospitalizations (61.4%) were for non-Hispanic Black patients.
• Non-Hispanic Black patients had lower rates of cardiac catheterization (61.7% vs 72.5%) and revascularization (38.4% vs 52.1%) compared to White patients (P < .001 for all).
• The lower rates of cardiac catheterization and revascularization persisted after adjusting for potential confounding factors.

“The results highlight a disparity that must be further investigated in this specific population, since a history of drug use and race should not affect whether to proceed with an invasive procedure that could potentially be lifesaving in the long term,” explained Jelani K. Grant, MD, Chief Medical Resident at the University of Miami and senior author of the study.

“Our hope is this study raises awareness of implicit biases that potentially exist when treating patients for ACS,” commented Carlos Vergara, MD, University of Miami resident and study coauthor. “Now that our findings suggest this bias exists, we can work together to help achieve health equity by evaluating other social determinants of health, which may be related to race and a history of cocaine use.”

According to SCAI, the authors plan to work with the community and other cardiologists to create actionable steps to ensure health equity across all cardiovascular diseases and treatments, regardless of race, socioeconomics, demographics, and substance abuse history.