To the Editor:
Benedek and colleagues note that African American patients had more medical comorbidities and were more likely to receive treatment from hospitals that were either academic or had percutaneous coronary intervention capabilities. We agree that this is an interesting observation. To separate the potential for confounding from this and other differences in the populations, we controlled for hospital characteristics (including teaching status) and medical comorbidities. In addition, we utilized the generalized estimating equation in our models to account for clustering of hospitals.
The authors also note that the median door‐to‐balloon (DTB) time is higher in females than in males. They question whether this could impact the observation that there were gender‐specific racial disparities. We agree with the observation that the median DTB is higher in females than males; however, these small differences in the groups would not affect the ability to show significant differences in either median DTB or the proportion of women who have a DTB ≤90 minutes.
Matthew A. Cavender, MD, MPH TIMI Study Group Heart and Vascular Center Brigham and Women's Hospital and Harvard Medical School Boston, Massachusetts Andrew N. Rassi, MD Department of Medicine Lee H. Schwamm, MD Department of Neurology Massachusetts General Hospital Boston, Massachusetts Gregg C. Fonarow, MD Department of Medicine Ronald Reagan–UCLA Medical Center Los Angeles, California Christopher P. Cannon, M.D. Professor of Medicine, Harvard Medical School Senior Physician, Cardiovascular Division, Brigham and Women's Hospital, Boston MA Executive Director Cardiometabolic Trials Harvard Clinical Research Institute W. Frank Peacock, MD Department of Emergency Medicine Baylor College of Medicine Houston, Texas Warren K. Laskey, MD, MPH Department of Medicine University of New Mexico Albuquerque, New Mexico Adrian F. Hernandez, MD Eric D. Peterson, MD, MPH Margueritte Cox, MS Marie Grau‐Sepulveda, MD Duke Clinical Research Institute, Durham, NC Deepak L. Bhatt, MD, MPH Heart and Vascular Center, Brigham and Women's Hospital Harvard Medical School Boston, MA