Racial and Ethnic Disparities in the Management and Outcomes of Acute Myocardial Infarction Complicated by Ventricular Arrhythmias.

Background

Ventricular arrhythmias (VAs) represent a high-risk complication of acute myocardial infarction (AMI) and are associated with high morbidity and mortality. Racial and ethnic disparities in the management and in-hospital outcomes of AMI with VAs remain incompletely understood.

Methods

Using the National Inpatient Sample, we conducted a retrospective analysis of hospitalizations in which AMI was complicated by VAs from 2002 to 2022. Hospitalizations were stratified by race/ethnicity including White, Black, Hispanic, and other racial/ethnic groups. Baseline characteristics and in-hospital outcomes were compared across groups.

Results

We identified 902,398 hospitalizations in which AMI was complicated by VAs, of which 78.2% occurred among White, 9.6% among Black, 6.3% among Hispanic, and 5.9% among patients of other racial/ethnic groups. Compared with White patients, Hispanic (aOR 1.21; CI 1.14-1.28) and patients in other racial/ethnic groups (aOR 1.31; CI 1.24-1.39) had higher odds of in-hospital mortality while Black patients had similar odds. In terms of procedural utilization, Black (aOR 0.65; CI 0.62-0.68), Hispanic (aOR 0.82; CI 0.77-0.86), and other racial/ethnic groups (aOR 0.89; CI 0.85-0.94) all had lower odds of percutaneous coronary intervention (PCI) relative to White patients. Black patients also had lower odds of coronary artery bypass grafting (CABG) (aOR 0.69; CI 0.64-0.74) and implantable cardioverter-defibrillator (ICD) insertion (aOR 0.84; CI 0.74-0.96) compared with White patients during admission.

Conclusions

Racial and ethnic disparities exist in the prevalence, management, and in-hospital outcomes of AMI complicated by VAs. Further efforts are needed to address differences in care in this high-risk population.