Abstract
Background: Recent evidence continues to show the benefit of drug-eluting stents (DES) over bare metal stents (BMS) in patient outcomes following ST-elevation myocardial infarction (STEMI), although the use of DES may be contraindicated in patients with specific comorbidities. In this study, we investigated racial/ethnic and gender disparities in the use of DES, after controlling for the effects of age, insurance status, secular trends, and comorbidities. Methods: The study population included all STEMI patients (n=60,218) who received PCI and at least one stent in any Florida acute-care hospital during 2006-2012. Hospital discharge data were analyzed. Procedure codes identified DES (ICD-9-CM 36.07) and BMS (ICD-9-CM 36.06). We used logistic regression to model the odds of receiving a DES. Potential predictors included in the model were patient age, racial/ethnic-gender group (referent=White men), year, payer (referent=commercial), diabetes, atrial fibrillation (AFIB), chronic kidney disease (CKD), and end-stage renal disease (ESRD). Results: Among all STEMI patients, Hispanic women were most likely to receive a DES (61.2%) and Black men were least likely (46.8%). Furthermore, the % of patients who received no stent also varied from 6.7% among Hispanic men to 12.8% among Black women. Multivariable logistic regression results were highly significant, with included independent variables significantly predictive of the odds of receiving a DES in the expected directions. After adjustment and compared with White men, Hispanic women were 24% more likely to receive a DES (OR 1.24, 95%CI 1.13-1.37), White women were 8% more likely to receive a DES (p=0.001), and Black women were 15% less likely to receive a DES (OR 0.85, 95% CI 0.76-0.95). There were no significant differences in DES usage for Hispanic men or for men or women or “other” race/ethnicity. The strongest disparity was observed for Black men, who were 32% less likely to receive a DES than White men (OR 0.68, 95% CI 0.63-0.74, p<0.0001). Conclusions: In this real-world analysis of unselected and recent STEMI patients, a significant disparity in use of DES for Black men and women was observed. This disparity was not explained by patient age, payer or comorbidities, nor by the secular trend.
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