{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T07:17:00Z","timestamp":1793258220047,"version":"4.5.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2023,7,18]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Systems of care have been developed across the United States to standardize care processes and improve outcomes in patients with ST-segment\u2013elevation myocardial infarction (STEMI). The effect of contemporary STEMI systems of care on racial and ethnic disparities in achievement of time-to-treatment goals and mortality in STEMI is uncertain.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We analyzed 178\u2009062 patients with STEMI (52\u2009293 women and 125\u2009769 men) enrolled in the American Heart Association Get With The Guidelines\u2013Coronary Artery Disease registry between January 1, 2015, and December 31, 2021. Patients were stratified into and outcomes compared among 3 racial and ethnic groups: non-Hispanic White, Hispanic White, and Black. The primary outcomes were the proportions of patients achieving the following STEMI process metrics: prehospital ECG obtained by emergency medical services; hospital arrival to ECG obtained within 10 minutes for patients not transported by emergency medical services; arrival-to\u2013percutaneous coronary intervention time within 90 minutes; and first medical contact\u2013to-device time within 90 minutes. A secondary outcome was in-hospital mortality. Analyses were performed separately in women and men, and all outcomes were adjusted for age, comorbidities, acuity of presentation, insurance status, and socioeconomic status measured by social vulnerability index based on patients\u2019 county of residence.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Compared with non-Hispanic White patients with STEMI, Hispanic White patients and Black patients had lower odds of receiving a prehospital ECG and achieving targets for door-to-ECG, door-to-device, and first medical contact\u2013to-device times. These racial disparities in treatment goals were observed in both women and men, and persisted in most cases after multivariable adjustment. Compared with non-Hispanic White women, Hispanic White women had higher adjusted in-hospital mortality (odds ratio, 1.39 [95% CI, 1.12\u20131.72]), whereas Black women did not (odds ratio, 0.88 [95% CI, 0.74\u20131.03]). Compared with non-Hispanic White men, adjusted in-hospital mortality was similar in Hispanic White men (odds ratio, 0.99 [95% CI, 0.82\u20131.18]) and Black men (odds ratio, 0.96 [95% CI, 0.85\u20131.09]).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Race- or ethnicity-based disparities persist in STEMI process metrics in both women and men, and mortality differences are observed in Hispanic White compared with non-Hispanic White women. Further research is essential to evolve systems of care to mitigate racial differences in STEMI outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.123.065512","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T18:00:33Z","timestamp":1689616833000},"page":"229-240","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Race-Based Differences in ST-Segment\u2013Elevation Myocardial Infarction Process Metrics and Mortality From 2015 Through 2021: An Analysis of 178 062 Patients From the American Heart Association Get With The Guidelines\u2013Coronary Artery Disease Registry"],"prefix":"10.1161","volume":"148","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1140-097X","authenticated-orcid":true,"given":"Asishana","family":"Osho","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston (A.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo F.","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Prisma Health, Hillcrest Hospital, Greenville, SC (M.F.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2028-8773","authenticated-orcid":true,"given":"Ram","family":"Poudel","sequence":"additional","affiliation":[{"name":"American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2211-7261","authenticated-orcid":true,"given":"James","family":"de Lemos","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas (J.d.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoyun","family":"Hong","sequence":"additional","affiliation":[{"name":"American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Zhao","sequence":"additional","affiliation":[{"name":"American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9322-6516","authenticated-orcid":true,"given":"Shen","family":"Li","sequence":"additional","affiliation":[{"name":"American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathie","family":"Thomas","sequence":"additional","affiliation":[{"name":"American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Osler Medical Residency, Johns Hopkins Hospital, Baltimore, MD (D.S.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5650-0464","authenticated-orcid":true,"given":"Jessica","family":"Zegre-Hemsey","sequence":"additional","affiliation":[{"name":"School of Nursing, University of North Carolina, Chapel Hill (J.Z-H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasrien","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health, Boston, MA (N.I.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3519-8662","authenticated-orcid":true,"given":"Nilay S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, Northwestern University Medical School, Chicago, IL (N.S.S., C.W.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Hollowell","sequence":"additional","affiliation":[{"name":"American Heart Association, Dallas, TX (R.P., H.H., J.Z., S.L., K.T., L.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2991-8769","authenticated-orcid":true,"given":"Jacqueline","family":"Tamis-Holland","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Foundation, OH (J.T-H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0045-3291","authenticated-orcid":true,"given":"Christopher B.","family":"Granger","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Durham, NC (C.B.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2038-6070","authenticated-orcid":true,"given":"Mauricio","family":"Cohen","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Florida, Weston (M.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1123-0533","authenticated-orcid":true,"given":"Timothy","family":"Henry","sequence":"additional","affiliation":[{"name":"The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (T.H., J.G.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2428-2458","authenticated-orcid":true,"given":"Alice K.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Boston University Medical Center, MA (A.K.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8459-996X","authenticated-orcid":true,"given":"James G.","family":"Jollis","sequence":"additional","affiliation":[{"name":"The Christ Hospital Heart and Vascular Institute, Cincinnati, OH (T.H., J.G.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7271-4166","authenticated-orcid":true,"given":"Clyde W.","family":"Yancy","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, Northwestern University Medical School, Chicago, IL (N.S.S., C.W.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6286-2349","authenticated-orcid":true,"given":"Abhinav","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.184043"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0B013E3182742CF6"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/HCQ.0000000000000032"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.032446"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0027-9684(15)31109-3"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12335"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.044107"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.165"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.13.1563"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.02.039"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9149(02)02296-8"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.109.917112"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2013.03.078"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.008096"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.10.882"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2011-000726"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.20149"},{"key":"e_1_3_3_19_2","first-page":"34","article-title":"Measuring community vulnerability to natural and anthropogenic hazards: the Centers for Disease Control and Prevention\u2019s social vulnerability index.","volume":"80","author":"Flanagan BE","year":"2018","unstructured":"Flanagan, BE, Hallisey, EJ, Adams, E, Lavery, A. 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