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?