Racial gap remains in invasive management for patients with MI with chronic kidney disease
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In a cohort of patients with MI and mild or moderate chronic kidney disease, Black individuals were less likely to receive invasive management compared with their white counterparts, researchers reported.
“This racial treatment gap merits concern as invasive management is associated with lower short- and long-term risk of MACE in both Black and white patients,” Jennifer A. Rymer, MD, MBA, interventional cardiologist at Duke University Hospital, assistant professor of medicine at Duke University School of Medicine and member in the Duke Clinical Research Institute, and colleagues wrote.
For the nationwide study, Rymer and colleagues assessed 717,012 white and 99,882 Black patients with MI from the National Cardiovascular Data Registry Chest Pain-MI Registry. Patients received treatment from 2008 to 2017 at 914 hospitals.
Rymer and colleagues classified chronic kidney disease (CKD) severity as an estimated glomerular filtration rate (eGFR) of less than 90 mL/min/1.73 m2 but at least 60 mL/min/1.73 m2 for mild; less than 60 mL/min/1.73 m2 but at least 30 mL/min/1.73 m2 for moderate; and less than 30 mL/min/1.73 m2 or dialysis for severe.
In all, 58.5% of white patients and 61.4% of Black patients had CKD (P < .001). Among the subset of individuals with MI and CKD, Black patients were more likely to have severe CKD (21.2% vs. 12.4%; P < .001).
Furthermore, diabetes and HF were more common for patients with CKD than for those without CKD, whereas black patients with CKD had an increased likelihood of having these comorbidities compared with white patients with CKD (P for all < .0001).
Researchers also found that Black race (adjusted OR = 0.78; 95% CI, 0.75-0.81) and CKD (aOR = 0.72; 95% CI, 0.7-0.74; P for both < .001) yielded a decreased likelihood of invasive management, defined as CABG or diagnostic coronary angiography with or without PCI, and that at eGFR levels of at least 10 mL/min/1.73 m2, Black patients were significantly less likely to undergo invasive management.
“It is unclear and concerning why such disparities continue to exist with the results of our study,” Rymer and colleagues wrote. “Although differences in care can often be attributed to differences in comorbidities and presenting features, we adjusted for most of these characteristics. These findings then raise the question of whether implicit bias could potentially impact the initial decision about whether to pursue an invasive strategy. National efforts are needed to address potential racial disparities that may remain in the invasive management of patients with MI to improve short- and long-term outcomes.”
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