Insurance status and the treatment of myocardial infarction at academic centers

Acad Emerg Med. 2004 Apr;11(4):343-8. doi: 10.1197/j.aem.2003.12.017.


Numerous studies have documented treatment disparities in patients with acute coronary syndromes based on race and gender. Other causes for treatment disparities may exist.

Objectives: To determine if insurance status affects quality of care in patients with acute myocardial infarction (AMI) presenting to academic health centers.

Methods: The Internet Tracking Registry for Acute Coronary Syndromes (i*trACS), a prospective multicenter registry of patients with chest pain presenting to the emergency department who receive an electrocardiogram, was used as the database (N = 17,737). A subset of patients who were diagnosed as having AMI were selected from the database (n = 936). Patients were classified as having either ST-segment elevation MI (n = 178) or non-ST-segment elevation MI (n = 758). Insurance status, age, race, and gender were extracted as predictor variables. The influence of predictor variables on treatment modality was investigated using logistic regression, adjusted for clustering within sites.

Results: The odds of a self-pay patient with ST-segment elevation MI receiving fibrinolytics were 3.23 (95% CI = 1.56 to 6.69) times higher than for other patients. Patients with Medicare coverage were less likely to receive fibrinolytics (odds ratio [OR] 0.35, 95% CI = 0.19 to 0.65) and tended to undergo percutaneous coronary intervention less often (OR 0.60, 95% CI = 0.36 to 1.01). The odds of a privately insured patient's receiving coronary artery bypass grafting (OR 2.76, 95% CI = 1.62 to 4.72) or percutaneous coronary intervention (OR 1.47, 95% CI = 1.03 to 2.11) were higher than for other patients.

Conclusions: Insurance coverage appears to affect treatment in patients with AMI, with self-pay patients more likely to receive less-expensive therapies and insured patients more likely to receive invasive treatments.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers / statistics & numerical data*
  • Age Distribution
  • Aged
  • Catheter Ablation / statistics & numerical data
  • Female
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Insurance, Health / statistics & numerical data*
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / economics*
  • Myocardial Infarction / therapy*
  • Odds Ratio
  • Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
  • Prospective Studies
  • Quality of Health Care / statistics & numerical data*
  • Racial Groups / statistics & numerical data
  • Sex Distribution
  • Singapore
  • Thrombolytic Therapy / statistics & numerical data
  • United States


  • Platelet Glycoprotein GPIIb-IIIa Complex