Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 2;8(9):e2532660.
doi: 10.1001/jamanetworkopen.2025.32660.

Disparities by Race and Ethnicity in Percutaneous Coronary Intervention

Charleen Hsuan  1 , Michelle P Lin  2 , Alexis Zebrowski  3   4   5 , Renee Y Hsia  6   7 , Brendan G Carr  3   4 , David J Vanness  1 , Eric K Wei  3   8 , David G Buckler  3 , Haoyu Bi  1 , Jeannette A Rogowski  1
Affiliations

Disparities by Race and Ethnicity in Percutaneous Coronary Intervention

Charleen Hsuan et al. JAMA Netw Open. .

Abstract

Importance: Hispanic and non-Hispanic Black patients with ST-segment elevation myocardial infarction (STEMI) are less likely than White non-Hispanic patients to receive guideline-recommended percutaneous coronary intervention (PCI). Research suggests disparities arise before and during STEMI treatment, but it is unclear when the largest disparities in PCI emerge.

Objective: To assess when in the care process the largest disparities in PCI receipt occur in patients with STEMI presenting to an emergency department.

Design, setting, and participants: This cross-sectional study evaluated adult patients with STEMI presenting to Florida hospitals from January 1, 2011, to December 31, 2021. Data were analyzed from June 29, 2023, to May 29, 2025.

Exposure: Patient race and ethnicity.

Main outcomes and measures: The main outcomes were presentation to PCI-capable hospitals, receipt of PCI if initially presenting to PCI-capable hospitals, transfer if initially presenting to non-PCI capable hospitals, and receipt of PCI at receiving hospital if transferred. Logistic regression was used to compare outcomes for patients with STEMI by race and ethnicity, controlling for payer, age, sex, weekend presentation, time of presentation, comorbidities, and hospital characteristics.

Results: Among 139 629 patients with STEMI included in the analysis, 68.81% were male. Mean (SD) age was 64.4 (13.0) years. A total of 9.09% identified as Black, 15.17% as Hispanic, 70.56% as White, and 5.17% as other or missing race. In adjusted analyses, Black (-1.8 [95% CI, -2.6 to 1.1] percentage points [pp]) and Hispanic (-3.1 [95% CI, -3.7 to -2.4] pp) patients were less likely than White patients to present to PCI-capable hospitals (P < .001 for both). Among patients initially presenting to PCI-capable hospitals, Black patients were less likely to receive PCI than White patients (-8.6 [95% CI, -9.5 to -7.7] pp; P < .001). Among patients initially presenting to non-PCI-capable hospitals, Black (-4.0 [95% CI, -6.4 to -1.5] pp; P = .001) and Hispanic (-4.2 [95% CI, -6.3 to -2.0] pp; P < .001) patients were less likely to be transferred than White patients. Among transferred patients, Black patients were less likely to undergo PCI at the receiving hospital than White patients (-13.3 [95% CI, -16.6 to -9.9] pp; P < .001).

Conclusions and relevance: In this cross-sectional study examining racial and ethnic disparities in receipt of PCI for patients with STEMI, racial and ethnic disparities persisted throughout the care process. The largest magnitude of disparity was PCI receipt if transferred, but the disparity with the largest impact was PCI receipt when initially presenting to PCI-capable hospitals.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Hsuan reported being a member of a Technical Expert Panel for the Equity of Emergency Care Capacity and Quality Team for the Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation, a member of National Quality Forum Committee on Attribution for Critical illness and Injury, and a Health Affairs Health Equity Fellowship Trainee. Dr Lin reported receiving grant support from the National Heart, Lung, and Blood and Institute (NHLBI), the National Institute on Aging, and the Emergency Medicine Foundation outside the submitted work; and having a leadership position at the American College of Emergency Physicians Emergency Medicine Data Institute Board of Governors. Dr Zebrowski reported receiving grant support from Pennsylvania State University during the conduct of the study and grant support from University of Nebraska outside the submitted work. Dr Hsia reported receiving grant support from the NHLBI during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Difference in Probability of Presentation of Patients With ST-Segment Elevation Myocardial Infarction to a Percutaneous Coronary Intervention (PCI)–Capable Hospital
Non-Hispanic White patients were the comparison group. Overall indicates the overall population-based model, which used robust SEs and controlled for visit and hospital characteristics. Medicare indicates the overall regression model in which the sample consisted only of Medicare patients. Other or missing race was excluded from the figure for clarity but included in the regression. Error bars indicate 95% CI.
Figure 2.
Figure 2.. Difference in Probability of Receipt of Percutaneous Coronary Intervention (PCI) at the Initial Hospital When a Patient With ST-Segment Elevation Myocardial Infarction Initially Presented to a PCI-Capable Hospital
Non-Hispanic White patients were the comparison group. Overall indicates the overall population-based model, which used robust SEs and controlled for visit and hospital characteristics. Medicare only indicates the overall regression model in which the sample consisted only of Medicare patients. Within hospital indicates a hospital fixed-effects model that controlled for visit characteristics and hospital fixed effects and indicates the difference compared with a non-Hispanic White patient within the same hospital. Other or missing race was excluded from the figure for clarity but included in the regression. Error bars indicate 95% CI.
Figure 3.
Figure 3.. Probability of Transfer When a Patient With ST-Segment Elevation Myocardial Infarction Initially Presented to a Non–Percutaneous Coronary Intervention (PCI)–Capable Hospital
Non-Hispanic White patients were the comparison group. Overall indicates the overall population-based model, which used robust SEs and controlled for visit and hospital characteristics. Medicare only indicates the overall regression model in which the sample consisted of Medicare patients only. Within hospital indicates a hospital fixed-effects model that controlled for visit characteristics and hospital fixed effects and indicates the difference compared with a White non-Hispanic patient within the same hospital. Other or missing race was excluded from the figure for clarity but included in the regression. Error bars indicate 95% CI.
Figure 4.
Figure 4.. Probability of Receipt of Percutaneous Coronary Intervention (PCI) at a Receiving Hospital When a Patient With ST-Segment Elevation Myocardial Infarction Initially Presented to a Non–PCI-Capable Hospital and Was Transferred
Non-Hispanic White patients were the comparison group. Overall indicates the overall population-based model, which used robust SEs and controlled for visit and hospital characteristics. Medicare only indicates the overall regression model in which the sample consisted only of Medicare patients. Within hospital indicates a hospital fixed-effects model that controlled for visit characteristics and hospital fixed effects. Other or missing race was excluded from the figure for clarity but included in the regression. Error bars indicate 95% CI.
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamanetworkopen.2025.32669

References

    1. Ariss RW, Minhas AMK, Issa R, et al. Demographic and regional trends of mortality in patients with acute myocardial infarction in the United States, 1999 to 2019. Am J Cardiol. 2022;164:7-13. doi: 10.1016/j.amjcard.2021.10.023 - DOI - PubMed
    1. Glance LG, Joynt Maddox KE, Shang J, et al. The COVID-19 pandemic and associated inequities in acute myocardial infarction treatment and outcomes. JAMA Netw Open. 2023;6(8):e2330327. doi: 10.1001/jamanetworkopen.2023.30327 - DOI - PMC - PubMed
    1. Bouisset F, Ruidavets JB, Dallongeville J, et al. Comparison of short- and long-term prognosis between ST-elevation and non–ST-elevation myocardial infarction. J Clin Med. 2021;10(2):180. doi: 10.3390/jcm10020180 - DOI - PMC - PubMed
    1. Thrane PG, Olesen KKW, Thim T, et al. Mortality trends after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2023;82(10):999-1010. doi: 10.1016/j.jacc.2023.06.025 - DOI - PubMed
    1. Krumholz HM, Bradley EH, Nallamothu BK, et al. A campaign to improve the timeliness of primary percutaneous coronary intervention: Door-to-Balloon: an Alliance for Quality. JACC Cardiovasc Interv. 2008;1(1):97-104. doi: 10.1016/j.jcin.2007.10.006 - DOI - PubMed

MeSH terms

LinkOut - more resources