Cardiac procedure use following acute myocardial infarction among American Indians

Background: The prevalence of coronary heart disease is rising among American Indians (Als), but there is limited evidence describing processes of care for Al with acute myocardial infarction (AMI). We compared rates of cardiac catheterization, percutaneous coronary intervention (PCl), and coronary artery bypass graft (CABG) surgery between Al and whites with AMI. Methods: Using data from the Nationwide Inpatient Sample and the Indian Health Service National Patient Information Reporting System, we identified 2511 Al and 3 16526 whites older than 30 years admitted with AMI during 1998 to 2001. Comparisons of cardiac procedure use between Al and whites were performed after adjusting for comorbid conditions and after stratifying by geographic region. Results: American Indians were less likely than whites to undergo cardiac catheterization and PCl in 3 of 4 geographic regions, with the largest difference occurring in the West South Central region (OR 0.32, 95% CI 0.24 to 0.43 for catheterization; OR 0.43, 95% CI 0.31 to 0.57 for PCl). American Indians were less likely than whites to undergo CABG surgery among diabetic patients (OR 0.48, 95% CI 0.32-0.73), but not among nondiabetic patients (OR 0.90, 95% CI 0.72-1.12). There were no differences in rates of PCl and CABG surgery between Als and whites among those receiving cardiac catheterization. Conclusions: Differences in the performance of coronary procedures are concentrated in western regions of the United States and are especially related to access to cardiac catheterization. Future studies are indicated to elucidate the mechanisms of these differences in care and their impact on clinical outcomes.