Abstract Body (Do not enter title and authors here): Background: Acute myocardial infarction (AMI) is associated with high morbidity and mortality which are experienced disproportionately by minoritized populations. We sought to evaluate racial differences in mortality and treatment received in a contemporary population of patients with AMI.
Methods: A retrospective analysis of data of U.S. Medicare fee-for-service beneficiaries from 2015 to 2019 was performed. Non-Hispanic Black and White patients admitted with diagnosis of AMI aged 45 years and above were identified. Cox models adjusted for age (categorized into 3 groups), sex and Charlson comorbidity index were used to determine the association of race with 30- and 90-day all-cause mortality.
Results: 814,593 patients hospitalized for AMI were included in this analysis. Of these, 76,514 (9.4%) were non-Hispanic Black (NHB). Following adjustment, a significant interaction between age group and race was observed, as such stratified hazard ratio (HR) estimates are presented. Among patients aged 45- 64 years, there was no significant difference in 30-day mortality risk, but a higher 90-day mortality risk was observed in NHB patients compared with non-Hispanic White (NHW) patients (HR: 1.07, 95% CI: 1.01 - 1.12). Among those aged 65 – 84 years, a higher mortality risk was observed at 30 and 90 days for NHB patients compared to NHW (HR: 1.11 and 1.14 respectively). However, a mortality crossover was observed for those aged 85 and older with NHB patients having a significantly lower mortality risk at 30 and 90 days (HR: 0.90 and 0.94 respectively) compared with NHW patients. In this AMI population, NHB patients were less likely to receive invasive revascularization therapy, including percutaneous coronary intervention and coronary artery bypass graft, when compared to NHW patients. However, for both racial groups, invasive therapy resulted in lower 30 and 90-day mortality rates by at least 50% (p<0.01) compared to those that received conservative treatment.
Conclusion: Racial gaps persist in invasive revascularization therapy and short-term mortality following AMI, with variations in mortality observed among younger and older adults. Intentional public health efforts and targeted interventions are needed to eliminate these disparities.