Black Race, Low Income Tied to Reduced Odds of Coronary Revascularization Post-AMI

Among postmenopausal women presenting with acute myocardial infarction (AMI), Black race and low income are associated with a decreased likelihood of receiving coronary revascularization, according to a study published in the American Heart Journal.

The Women’s Health Initiative (WHI)—a national health study sponsored by the National Institutes of Health, National Heart, Lung, and Blood Institute—followed postmenopausal US women for over 20 years to assess cardiovascular disease. AMI included ST-segment elevation MI (STEMI) and non–ST-segment elevation myocardial infarction (NSTEMI). The type of revascularization used in patients with AMI included percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).

A total of 5284 postmenopausal women from WHI with AMI were enrolled in the study. The cumulative incidence of coronary revascularization from 2005 through 2019 was examined. Hazard ratios (HRs) of revascularization for AMI were compared among Black and Hispanic women vs White women, as well as among women with annual incomes of less than $20,000 per year (low income) vs those with annual incomes of $20,000 or more per year, over a median of 9.5 years of follow-up (between 1993 and 2019), with baseline enrollment from 1993 to 1998. The primary study outcome was receipt of coronary revascularization.

Among the women who were evaluated, 2.8% were Hispanic, 9.5% were Black, and 87.7% were White. Overall, the yearly income of 23.2% of the participants was less than $20,000. Per fully adjusted analyses, Black race compared with White race was associated with a significantly lower likelihood of receiving coronary revascularization for AMI (HR, 0.79; 95% CI, 0.66 to 0.95; P=.01).

Further, Black race compared with White race was associated with a significantly lower probability of receiving PCI for AMI (HR, 0.72; 95% CI, 0.59 to 0.90; P<.09) but not for those receiving CABG (HR, 0.97; 95% CI, 0.72 to 1.32; P=.86). Low income was associated with a significantly decreased likelihood of receiving coronary revascularization (HR, 0.90; 95% CI, 0.82 to 0.99; P=.04).

The investigators stated, “Our findings suggest that race and income merit consideration in the complex management of AMI. Additional investigation with patients, community stakeholders, and health care professionals is needed to develop timely interventions that invoke anti-racist principles.”  

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  

Reference  

Tertulien T, Roberts MB, Eaton CB, et al. Association between race/ethnicity and income on the likelihood of coronary revascularization among postmenopausal women with acute myocardial infarction: Women’s Health Initiative Study.  Am Heart J. Published online January 6, 2022. doi:10.1016/j.ahj.2021.12.013