Published on March 3, 2014
SAEM Western Regional Meeting, March 17, 2012 Garren M.I. Low, MS LAC+USC Medical Center Los Angeles, CA
Ethnic Disparities in the Utilization of EMS Resources and the Impact on Door-ToPCI Times in STEMI Patients Nick Testa, M.D.; Garren Low, MS; David Shavelle, M.D.; Stephanie Hall, M.D.; Kim Newton, M.D.; Linda Chan, Ph.D.
Background LAC+USC is a STEMI Receiving Center (since January 2008) National standard for Door-to-PCI time is ≤90 minutes Previous research from LAC+USC showed Hispanics have disproportionately long Doorto-PCI time Hispanic-Americans STEMI patients have been shown to have poorer times and outcomes in the literature
Methods All patients treated for STEMI at LAC+USC January 2009 – June 2011 Data prospectively collected by cross trainedCCU nurses: “STEMI Nurses” Data cleaned by Project Coordinator & Biostatistics staff
Results 494 patients over this time period 276 (56%) Hispanic 95 (19%) African American 64 (13%) Asian 59 (12%) Caucasian
Results: % of cases with Door-To-PCI time ≤90 Minutes EMS Walk-In Subtotal Hispanics 55/60 (92%) 48/77 (62%) 103/137 (75%) African Americans 20/21(95%) 1/4 (25%) 21/25 (84%) Subtotal 75/81 (92%) 49/81 (60%) 124/162 (77%) Crude Odds Ratio (Hispanic vs. AA) 0.58 (95%CI: 0.16, 1.95; p=0.48) Adjusted Odds Ratio (Hispanic vs. AA) 1.54 (95%CI: 0.33, 6.63; p=0.80)
Results: EMS Utilization African American STEMI Patients utilized EMS 70% of the time Hispanic STEMI Patients utilized EMS 40% of the time
Discussion The reverse relationship between the Crude Odds Ratio and Adjusted Odds ratio Suggests that there is an interaction between Entry Mode (EMS Utilization) and the Door-to-PCI time, as viewed by ethnicity
Conclusion Significant difference between EMS and Walk-In STEMI patients’ Door-to-PCI times No significant difference between African American and Hispanic STEMI patients after adjusting for EMS utilization.
Limitations Data is from one medical center Small sample size Population is multicultural, urban Paper will look at a longer time period No adjustment for patient co-morbidities
No Conflicts of Interest
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