Studies Find Underrepresented Groups Remain at Highest Risk of Heart Attack Despite 50% National Incidence Decline

May 3, 2024—Two studies focusing on ST‐segment elevation myocardial infarction (STEMI) uncovered socioeconomic, race, and gender disparities that are associated with greater risk and less likelihood to receive certain procedures.

Investigators found that low-income patients are at greater risk of STEMI despite the incidence of STEMI decreasing approximately 50% in 15 years. Additionally, women, Black, and Hispanic patients were up to 25% less likely to receive potential life-saving procedures after non-STEMI (NSTEMI).

The studies’ data were revealed in the following presentations at SCAI 2024, the Society for Cardiovascular Angiography & Interventions scientific sessions held May 2-4 in Long Beach, California:

• “Demographic Trends in ST-Elevation Myocardial Infarction Incidence and Mortality in the United States”
• “Identifying Gender and Racial Disparities in Interventional Management of NSTEMI: A Nationwide Analysis”

“Advancing science in focus areas that bring to light disparities that exist is important to understand where we, as health care innovators, need to do more,” commented SCAI President George D. Dangas, MD, in the society’s press release. “As the leading organization representing interventional cardiologists, it is up to us to start the conversation on these injustices, so we can address them and provide equitable care for all.”

As summarized in the SCAI press release, the first study was led by Fares Ghanem, MD. The investigators analyzed nationwide inpatient data from 2004 to 2020. They calculated annual hospitalization per population rates and assessed trends through regression analysis of demographic trends in STEMI hospitalizations across the United States.

Lower-income patients were found to be at greater risk of experiencing STEMI-related heart attacks.

A total of 3,426,898 eligible patients were analyzed. The overall incidence of STEMI steadily decreased from 98.7 per 100,000 inpatient hospitalizations per population in 2004 to 49 in 2020 (P < .01), primarily among older individuals.

• STEMI incidence increased in small- and medium-sized hospitals but decreased in large hospitals.
• Mortality decreased from 25% to 22% for patients aged > 85 years and from 13% to 10.5% for patients aged 65 to 84 years.
• Mortality slightly rose from 4% to 5.5% in the 45 to 65 age group and maintained a consistent rate of approximately 2.5% to 3% in patients aged 18 to 44.
• Higher STEMI incidence and mortality were observed in the lower-income population.

On average, the incidence of STEMI was relatively 20% lower in higher-income populations than lower-income populations, and this trend remained consistent from 2004 to 2020. It decreased from 107 to 54 per 100,000 population among those with low household income. In the high household income group, it decreased from 85 to 42 per 100,000 population. The study also observed higher mortality in lower-income populations, with adjusted odds of 1.12 (1.10-1.14; P < .01).

“Seeing a decline in STEMI overall was surprising,” commented Dr. Ghanem in the SCAI press release. “However, the disparities uncovered by our study emphasize there is a gap in care.”

Dr. Ghanem, a cardiovascular disease physician at Southern Illinois University in Carbondale, Illinois, continued, “We encourage clinicians to focus on providing equitable access to high-quality care through increased education and implementing targeted interventions for vulnerable populations. Our goal is for our data to be used to help create better, more tailored care plans for patients across the country.”

In the second presentation, a retrospective analysis using National Inpatient Sample data from 2016 to 2020 showed that women, Black, and Hispanic patients were less likely to receive certain cardiovascular operations compared to men and White patients. The analysis included adult patients with specifically type 1 NSTEMI. Patients who underwent coronary angiography (CA) or percutaneous coronary intervention (PCI) for NSTEMI were identified using ICD-10 procedural codes.

Among the 2,153,124 NSTEMI patients, women had 18.4% lower adjusted odds of undergoing CA/PCI compared to men (P < .001). Black and Hispanic patients had 25.4% and 16.9% lower adjusted odds of undergoing CA/PCI compared to White patients, respectively (P < .001 for both). Similar disparities were observed with early interventional management (intervention within < 24 hours) in White and male patients when compared to another cohort.

The study was led by Mandvi Devendra Pandey, MD, a resident physician at Texas Health Resources in Denton, Texas.

“As health care professionals, we are trained to care for all our patients equally regardless of race or gender,” commented Dr. Pandey in the SCAI press release. “Yet, our study observed disparities in the interventional management of type 1 NSTEMI patients. It is crucial to address these disparities not only to enhance individual patient outcomes but also to advance health equity and social justice.”

Dr. Pandey concluded, “Our study can serve as a positive catalyst by raising awareness, advocating for targeted quality improvements and health care system reforms so everyone can have better cardiovascular care.”