Among those with ACS, history of cocaine use, procedures less common in Black patients
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ATLANTA — Among patients with ACS and a history of cocaine use, non-Hispanic Black patients were less likely than white patients to receive cardiac catheterization or revascularization, researchers reported.
For the study, presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions, the researchers analyzed 43,798 Black and white patients included in the National Inpatient Sample database from 2011 to 2019 who were hospitalized for ACS and had a history of cocaine use.
“The study was inspired by a patient who presented with non-STEMI at one of our hospitals and had a history of cocaine use,” Michael Dangl, MD, internal medicine resident at the University of Miami, told Healio. “He was Black and he did not receive catheterization for his heart attack. That prompted one of our chief residents, Jelani K. Grant, MD, and our program director, Stefanie Brown, MD, to wonder if part of the reason he didn’t receive the cath was because of his race. That sparked a discussion, and we wanted to look into it as a national trend to see if there were any racial disparities in white and Black patients in terms of catheterization and revascularization for patients with a history of cocaine use presenting with heart attacks.”
Among the cohort, 61.4% were Black. The outcomes of interest were rates of cardiac catheterization and revascularization (via PCI or CABG).
Compared with white patients, Black patients were older, more likely to be women, more likely to have income below the 50th percentile, more likely to have comorbidities, less likely to have STEMI and more likely to have non-STEMI or unstable angina (P < .001 for all), Dangl and colleagues found.
The rates of cardiac catheterization were 61.7% in Black patients and 72.5% in white patients, whereas the rates of revascularization were 38.4% for Black patients and 52.1% for white patients (P < .001 for both), according to the researchers.
After adjustment for age, sex, STEMI, tobacco use and certain comorbidities, non-Hispanic Black race was associated with reduced odds of receiving cardiac catheterization (adjusted OR = 0.765; 95% CI, 0.728-0.804) and revascularization (aOR = 0.676; 95% CI, 0.644-7.11).
“Among patients with a history of cocaine use, Black patients are about 25% less likely to receive catheterization and are also about 40% less likely to receive revascularization [for ACS],” Dangl told Healio. “One consideration for catheterization and revascularization is the patient’s ability to comply with dual antiplatelet therapy after PCI. Part of that consideration may be affected by substance-abuse stigma and racial bias. In our study, the Black population group tended to be of lower socioeconomic status, so that also could have played into concerns about compliance with antiplatelet therapy.”
In addition, he said, a partial explanation could be that Black patients were more likely to present at hospitals with low resources “that might not be willing to use their limited resources to perform these procedures in patients with a history of cocaine use.”
A remedy could be to use more objective measures when predicting ability to comply with a post-procedure medication regimen, Dangl told Healio. “Like how good are they with their follow-up [and] are they taking other medications, rather than trying to use subjective measures,” he said.
Implicit bias training and diversification of the CV workforce could also help reduce the disparity, he said.
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Dangl M, et al. Abstract 25. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 19-22, 2022; Atlanta.
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