2025-09-18 ペンシルベニア州立大学(PennState)
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<関連情報>
- https://www.psu.edu/news/health-and-human-development/story/not-all-heart-attack-patients-receive-same-type-care-researchers
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2839064
- https://www.jacc.org/doi/10.1016/j.jacc.2023.06.025
経皮的冠動脈インターベンションにおける人種・民族間の格差 Disparities by Race and Ethnicity in Percutaneous Coronary Intervention
Charleen Hsuan, JD, PhD; Michelle P. Lin, MD, MPH, MS; Alexis Zebrowski, PhD, MPH;et al
JAMA Network Open Published:September 18, 2025
DOI:10.1001/jamanetworkopen.2025.32660
Key Points
Question What hospital factors are associated with disparities by race and ethnicity in receipt of guideline-recommended percutaneous coronary intervention (PCI) among patients with ST-segment elevation myocardial infarction?
Findings In this cross-sectional study of 139 629 participants, Black and Hispanic patients were less likely than White patients to initially present to PCI-capable hospitals, receive PCIs if initially presenting to PCI-capable hospitals, be transferred if initially presenting to non–PCI-capable hospitals, and receive PCIs if transferred.
Meaning These findings suggest that 2 areas of focus could be standardizing hospital protocols at PCI-capable hospitals and improving hospital transfers.
Abstract
Importance Hispanic and non-Hispanic Black patients with ST-segment elevation myocardial infarction (STEMI) are less likely than White non-Hispanic patients to receive guideline-recommended percutaneous coronary intervention (PCI). Research suggests disparities arise before and during STEMI treatment, but it is unclear when the largest disparities in PCI emerge.
Objective To assess when in the care process the largest disparities in PCI receipt occur in patients with STEMI presenting to an emergency department.
Design, Setting, and Participants This cross-sectional study evaluated adult patients with STEMI presenting to Florida hospitals from January 1, 2011, to December 31, 2021. Data were analyzed from June 29, 2023, to May 29, 2025.
Exposure Patient race and ethnicity.
Main Outcomes and Measures The main outcomes were presentation to PCI-capable hospitals, receipt of PCI if initially presenting to PCI-capable hospitals, transfer if initially presenting to non-PCI capable hospitals, and receipt of PCI at receiving hospital if transferred. Logistic regression was used to compare outcomes for patients with STEMI by race and ethnicity, controlling for payer, age, sex, weekend presentation, time of presentation, comorbidities, and hospital characteristics.
Results Among 139 629 patients with STEMI included in the analysis, 68.81% were male. Mean (SD) age was 64.4 (13.0) years. A total of 9.09% identified as Black, 15.17% as Hispanic, 70.56% as White, and 5.17% as other or missing race. In adjusted analyses, Black (-1.8 [95% CI, -2.6 to 1.1] percentage points [pp]) and Hispanic (-3.1 [95% CI, -3.7 to -2.4] pp) patients were less likely than White patients to present to PCI-capable hospitals (P < .001 for both). Among patients initially presenting to PCI-capable hospitals, Black patients were less likely to receive PCI than White patients (-8.6 [95% CI, -9.5 to -7.7] pp; P < .001). Among patients initially presenting to non–PCI-capable hospitals, Black (-4.0 [95% CI, -6.4 to -1.5] pp; P = .001) and Hispanic (-4.2 [95% CI, -6.3 to -2.0] pp; P < .001) patients were less likely to be transferred than White patients. Among transferred patients, Black patients were less likely to undergo PCI at the receiving hospital than White patients (-13.3 [95% CI, -16.6 to -9.9] pp; P < .001).
Conclusions and Relevance In this cross-sectional study examining racial and ethnic disparities in receipt of PCI for patients with STEMI, racial and ethnic disparities persisted throughout the care process. The largest magnitude of disparity was PCI receipt if transferred, but the disparity with the largest impact was PCI receipt when initially presenting to PCI-capable hospitals.
ST上昇型心筋梗塞に対する一次経皮的冠動脈インターベンション後の死亡率の推移 Mortality Trends After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction
Pernille Gro Thrane , Kevin Kris Warnakula Olesen, Troels Thim, Christine Gyldenkerne, Martin Bødtker Mortensen, Steen Dalby Kristensen, and Michael Maeng
JACC Published:28 August 2023
Abstract
Background
Observational studies have reported that mortality rates after ST-segment elevation myocardial infarction (STEMI) have been stable since 2006 to 2010.
Objectives
The aim of this study was to evaluate the temporal trends in 1-year, 30-day, and 31- to 365-day mortality after STEMI in Western Denmark where primary percutaneous coronary intervention (PCI) has been the national reperfusion strategy since 2003.
Methods
Using the Western Denmark Heart Registry, the study identified first-time PCI-treated patients undergoing primary PCI (pPCI) for STEMI from 2003 to 2018. Based on the year of pPCI, patients were divided into 4 time-interval groups and followed up for 1 year using the Danish national health registries.
Results
A total of 19,613 patients were included. Median age was 64 years, and 74% were male. One-year mortality decreased gradually from 10.8% in 2003-2006, 10.4% in 2007-2010, 9.1% in 2011-2014, to 7.7% in 2015-2018 (2015-2018 vs 2003-2006: adjusted HR [aHR]: 0.71; 95% CI: 0.62-0.82). The largest absolute mortality decline occurred in the 0- to 30-day period with a 2.3% reduction (aHR: 0.69; 95% CI: 0.59-0.82), and to a lesser extent in the 31- to 365-day period (risk reduction: 1.0%; aHR: 0.71; 95% CI: 0.56-0.90).
Conclusions
In a high-income European country with a fully implemented pPCI strategy, 1-year mortality in pPCI-treated patients with STEMI decreased substantially between 2003 and 2018. Approximately three-quarters of the absolute mortality reduction occurred within the first 30 days after pPCI. These results indicate that optimization of early management of pPCI-treated patients with STEMI offers great opportunities for improving overall survival in contemporary clinical practice.
The last 2 decades have witnessed major changes in the management of ST-segment elevation myocardial infarction (STEMI).1,2 Some of the most wide-ranging changes are the implementation of primary percutaneous coronary intervention (pPCI) and the introduction of STEMI reperfusion networks as the cornerstones of reperfusion therapy. Although several observational studies have reported reductions in short- and long-term mortality in patients with STEMI,3-6 the most recent studies showed stagnating mortality rates since 2006 to 2010.5-10
In Denmark, pPCI was implemented as a national strategy in 2003 after the DANAMI-2 (Danish Acute Myocardial Infarction 2) trial11 showed that interhospital transport to pPCI was superior to fibrinolysis at the local hospital with a reduction in short- and long-term major adverse ischemic events.11,12 Subsequent improvements in the management of STEMI included establishment of a national reperfusion network with direct referral of patients to the catheterization laboratory (ie, bypassing local hospitals and emergency departments),13,14 a strategy also adopted in many other countries. Further advances include prophylactic medical treatment with high-intensity statins,15 new potent P2Y12 inhibitors,16 and the introduction of drug-eluting stents (DES).17 Furthermore, dedicated heart failure clinics and systematic cardiac rehabilitation programs have been established.18
It is not known whether mortality rates after STEMI are still on a decline or have stagnated in Denmark. The present study investigated 1-year, early (0-30 days), and late (31-365 days) mortality and related changes in management and treatment among patients treated with pPCI for STEMI in Western Denmark from 2003 to 2018. Denmark is an ideal case for studying changes in STEMI mortality in a high-income European country with full implementation of a pPCI-based strategy and fast uptake of guideline-recommended therapy.
