Racial Disparities in Outcomes of Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Secondary to Spontaneous Coronary Artery Dissection

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of ST-segment elevation myocardial infarction (STEMI), predominantly affecting women. Because primary percutaneous coronary intervention (PPCI) is reserved for a select group of patients, vulnerable and minority patients may suffer delays in appropriate management and adverse outcomes. We examined racial differences in the outcomes for SCAD patients undergoing PPCI for STEMI. Records of patients ≥18 years old who underwent PPCI for SCAD-related STEMI between 2016 and 2020 were identified from the National Inpatient Sample database. Clinical, socioeconomic, and hospital characteristics were compared between non-White and White patients. Weighted multivariate analysis assessed the association of race with inpatient mortality, length of stay (LOS), and hospitalization costs. The total weighted estimate of SCAD-STEMI patients undergoing PPCI was 4945, constituting 25% non-White patients. Non-White patients were younger (56 vs. 60.7 years, p<0.001), had a higher prevalence of diabetes, acute renal failure, and obesity, and were more likely to be uninsured and be in the lowest income group. Inpatient mortality (7.7% vs. 8.4%, p=0.74) and hospitalization costs ($34213 vs. $31858, p=0.27) were similar for non-White and White patients, and adjusted analysis did not show any association between patients’ race and inpatient mortality (odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.32-1.13; p=0.11) or hospitalization costs (β: 215; 95% CI: -4193 to 4623; p>0.90). Similarly, there was no association between patients’ race and LOS (incident rate ratio: 1.20; 95% CI: 1.00-1.45; p=0.054]. Weighted multivariate analysis showed that age; clinical comorbidities such as diabetes, acute renal failure, valvular dysfunction, and obesity; low-income status; and hospitalization in the Western region were associated with adverse outcomes. In conclusion, our study does not show any differences in inpatient mortality, length of stay, and hospitalization costs between non-White and White patients undergoing PPCI for SCAD-related STEMI.