Abstract 16082: Racial Differences Among Patients Undergoing Nuclear Myocardial Perfusion Imaging

Abstract

Introduction: Noninvasive cardiac stress testing is valuable for early diagnosis and optimizing management of patients with coronary artery disease (CAD). Historically, Black patients have experienced both underdiagnosis and undertreatment of CAD. We evaluated racial disparities in patients undergoing nuclear myocardial perfusion imaging (MPI). Different modalities (MPI (SPECT, PET) vs. stress echocardiography) have variations in accuracy, cost and radiation exposure, which may reflect provider biases. Methods: Patient-reported demographics, clinician-reported cardiac risk factors and MPI study characteristics from a large Connecticut health system (2016 - 2022) were compared for Black and White patients in both general and matched cohorts (1:1 matched for demographics and risk factors). Results: The study included 123,069 cardiac stress tests from 10.5% Black and 76.2% White patients (largely similar to overall Connecticut population: 12.7% Black, 78.8% White). Black patients were younger (56.7±13.3 vs. 62.1±13.4 years, p< 0.001), more likely female (58.7 vs. 44.7%, p<0.001) and had more risk factors (Table 1). Black patients were more likely to undergo MPI (66.6 vs. 50.5%, p<0.001), inpatient or observation status testing (17.0 vs. 8.4%, p< 0.001), with pharmacological rather than exercise stress (53.9 vs. 37.0%, p<0.001) than White patients. On analysis of the 1:1 matched cohort, Black patients younger than 65 years were more likely to undergo MPI than White patients (62.1 vs. 57.4%, p<0.001), while the reverse is seen for patients over 65 years old (37.5 vs. 42.5%, p<0.001). Conclusion: Significant demographic and stress testing pattern differences were found between Black and White patients. These findings may reflect racial disparities in cardiovascular care, including access and clinical referral patterns. Further studies are needed to determine if these differences in stress testing strategies impact downstream clinical outcomes.