Abstract 17640: Myocardial Infarction Quality of Care and Outcomes in Asian American Subgroups

Abstract

Introduction: Cardiovascular mortality differs across Asian American subgroups, but myocardial infarction (MI) hospitalization outcomes or quality of care have not been reported in these populations. Hypothesis: MI quality and outcomes differ among Asian Americans, with worse outcomes compared with non-Hispanic White (NHW) adults. Methods: Participants from 711 hospitals in the AHA Get with the Guidelines Coronary Artery Disease registry were age ≥18 years with ST-elevation MI (STEMI), identified as Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese, or NHW. Odds of in-hospital mortality, door-to-balloon time <90 minutes, and door-to-electrocardiogram (ECG) time <10 minutes were evaluated in each Asian American subgroup vs. NHW with sex-stratified multivariable logistic regression models, adjusted for age, CVD history, smoking, body mass index, LDL cholesterol, diabetes, hypertension, and health insurance. Results: Among Asian American (3,591 female; 10,660 male) and NHW (108,071 female; 224,899 male) patients with STEMI, adjusted odds of in-hospital mortality vs. NHW were higher in Korean (odds ratio [OR] 1.139, 95% confidence interval [CI] 1.021-1.271) and Vietnamese (OR 1.158, 95% CI 1.053-1.273) female patients (Figure). Likelihood of achieving door-to-balloon time <90 minutes among STEMI patients was lower in Chinese (OR 0.846, 95% CI 0.734-0.975) and Filipina (OR 0.699, 95% CI 0.616-0.793) female patients, and Chinese (OR 0.932, 95% CI 0.877-0.990), Filipino (OR 0.922, 95% CI 0.853-0.998), and Vietnamese (OR 0.890, 95% CI 0.812-0.976) male patients. Similar patterns were seen in achieving door-to-ECG time <10 minutes. Conclusions: STEMI outcomes and quality of care may vary among Asian American subgroups. Quality improvement programs must identify and address the factors that result in suboptimal MI outcomes and care among Asian American patients.