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-To-PCI Times in STEMI PatientsNick 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 Door-to-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 trained-CCU 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 Population is multicultural, urban

Small sample size Paper will look at a longer time period

No adjustment for patient co-morbidities

No Conflicts of Interest

Questions?