BLACK WOMEN DEMONSTRATE WORSE CORONARY ARTERY DISEASE BURDEN AND CLINICAL OUTCOMES WHEN ADMITTED WITH FIRST ACUTE MYOCARDIAL INFARCTION

Abstract

Therapeutic Area: ASCD/CVD in Women Background: We aimed to determine ethnic and gender discrepancies in coronary artery disease (CAD) burden and clinical outcomes in patients admitted with first acute myocardial infarction (AMI). Methods: We conducted retrospective analysis of middle-aged (35-60 years) patients admitted with AMI from 2017-2020. Ethnicity, gender, body mass index (BMI) and cardiovascular (CV) risk factors (history of smoking, diabetes mellitus, hypertension, hyperlipidemia, peripheral arterial disease, and chronic kidney disease) were analyzed. CAD burden was classified into single vessel disease (SVD), 2 vessel disease (2VD) and >2 or multiple vessel disease (MVD). Clinical outcomes were defined as type of intervention (PCI or CABG) and in-hospital mortality. Data was analyzed in STATA 16 and multinomial logistic regression was used to calculate adjusted (for age and CV risk factors) relative risk ratios (aRRR) for CAD burden and outcomes. Results: 434 patients (39.4% females) were divided into the following ethnicities: 61% Caucasians, 33% African Americans (AA), and 6% Hispanics. Mean age was 55+/-14 and mean BMI was 29 +/- 5.5 kg/m2. Analysis revealed higher occurrence of 2VD (aRRR 4.81, [2.64-7.22], p<0.001) and MVD (aRRR 8.23, [6.56-9.09], p<0.001) in AA vs. Caucasians (Figure 1). Hispanics showed increased incidence of 2VD (aRRR 2.21, [2.61-7.23], p<0.001) when compared to Caucasians. AA also had an increased rate of CABG (aRRR 4.11, [3.63-5.31], p<0.001) and in-hospital death (aRRR 3.61, [2.66-6.16], p<0.001). In contrast, Hispanics had similar rate of CABG and mortality compared to Caucasians. Subgroup analysis stratified by gender revealed an increased incidence of MVD (aRRR 3.21, [2.02-4.01], p<0.001) in AA females compared with other subgroups (Figure 2). Hispanic patients did not show a difference in CAD burden or clinical outcomes when stratified by gender. Conclusion: African American and Hispanic patients have increased incidence of 2VD and MVD during first AMI. AA females have the highest incidence of MVD when compared to other subgroups necessitating stricter optimization of cardiovascular health for this subset.