Racial Disparities in STEMI Care Process—Not All Roads Lead to Reperfusion

For patients presenting with acute coronary syndrome (ACS), evidence-based guidelines with the highest levels of recommendations outline care from initial assessment of suspected ACS to revascularization strategies to long-term follow-up and secondary prevention. 1 Prior work 2 has shown racial disparities in access to care, with fewer percutaneous coronary interventions (PCI) and higher mortality rates for Black and Hispanic patients compared with White patients presenting with ST-segment elevation myocardial infarction (STEMI).Disparities have the potential to be introduced at each step of the care process, from initial ACS assessment to long-term management after discharge.Addressing these racial disparities requires a nuanced understanding of when and how they emerge to support efforts to improve patient care for all.With this background, Hsuan et al 3 performed a cross-sectional study of adult patients presenting with a primary or discharge diagnosis of STEMI using merged statewide all-payer hospital discharge data from the Healthcare Cost and Utilization Project State Inpatient Database and State Emergency Department Database in Florida from 2011 to 2021.The study aimed to examine and quantify racial disparities from initial emergency department presentation to transfers for PCI.As such, the authors evaluated the association between race, defined as Hispanic, non-Hispanic Black, non-Hispanic White, and non-Hispanic other or missing, and 4 primary process outcomes: initial arrival at a PCI-capable hospital, receipt of PCI if initially at a PCI-capable hospital, interhospital transfer if initially at a non-PCI-capable hospital, and receipt of PCI following transfer.