Differences between South Asians and White Europeans in five year outcome following percutaneous coronary intervention

Department of Cardiology, City Hospital, Birmingham, UK.
International Journal of Clinical Practice (Impact Factor: 2.57). 12/2011; 65(12):1259-66. DOI: 10.1111/j.1742-1241.2011.02776.x
Source: PubMed


The aim of this study was to compare rates of target lesion revascularisation (TLR) and total mortality between South Asians (SAs) and White Europeans (WEs) following percutaneous coronary intervention (PCI).
We followed a cohort of 293 SAs and 865 WEs patients admitted for elective or urgent PCI to de novo lesions. For each patient, baseline cardiovascular risk factors and angiographic data were obtained. Patients had long-term follow-up for all-cause mortality and TLR.
Patients were followed up over a median period of 54 months (inter-quartile range: 47-65). SAs were younger (62 ± 12 years vs. 66 ± 11 years; p < 0.0001), with a higher prevalence of diabetes, greater social deprivation [Carstairs score: 10.2 (IQR 6.5-12.1) vs. 3.3 (IQR 0.9-6.5); p < 0.0001] and presented more acutely (urgent PCI procedure). During the follow-up period, a total of 119 deaths and 111 TLR [94 repeat PCI and 17 coronary artery bypass grafting (CABG)] occurred. There was no significant difference in the rate of long-term all-cause mortality between SA and WE [31 (10.6%) vs. 107 (12.4%); OR: 0.84 (0.55-1.28); p = 0.47]. However, SA ethnicity was an independent predictor of long-term TLR, after adjusting for baseline clinical and procedural characteristics [54 (18.4%) vs. 57 (6.6%); OR: 2.83 (1.87-4.29); p < 0.0001].
South Asian patients were more likely to require re-admission to treat clinical restenosis of the index lesion. There was no significant long-term difference in all-cause mortality between SA and WE patients.

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    • "Although no studies explored the ethnic differences in outcomes in the post-AMI post-revascularization setting, in patients with coronary artery disease who have undergone revascularization procedures, studies yielded conflicting results. Namely, while some studies reported no difference in mortality rates following PCI between South Asian and White patients [7,8], other observed lower mortality among Asian patients compared to their Western European counterparts [9]. Similarly, among studies exploring the ethnic differences in fatal cardiac outcomes following CABG, some studies reported higher mortality in South Asian compared to White patients [10-12], while others observed no such difference [13]. "
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    ABSTRACT: Little is known on whether there are ethnic differences in outcomes following percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) after acute myocardial infarction (AMI). We compared 30-day and long-term mortality, recurrent AMI, and congestive heart failure in South Asian, Chinese and White patients with AMI who underwent PCI and CABG. Hospital administrative data in British Columbia (BC), Canada were linked to the BC Cardiac Registry to identify all patients with AMI who underwent PCI (n = 4729) or CABG (n = 1687) (1999-2003). Ethnicity was determined from validated surname algorithms. Logistic regression for 30-day mortality and Cox proportional-hazards models were adjusted for age, sex, socio-economic status, severity of coronary disease, comorbid conditions, time from AMI to a revascularization procedure and distance to the nearest hospital. Following PCI, Chinese had higher short-term mortality (Odds Ratio (OR): 2.36, 95%CI: 1.12-5.00; p = 0.02), and South Asians had a higher risk for recurrent AMI (OR: 1.34, 95%CI: 1.08-1.67, p = 0.007) and heart failure (OR 1.81, 95%CI: 1.00-3.29, p = 0.05) compared to White patients. Risk of heart failure was higher in South Asian patients who underwent CABG compared to White patients (OR (95%CI) = 2.06 (0.92-4.61), p = 0.08). There were no significant differences in mortality following CABG between groups. Chinese and South Asian patients with AMI and PCI or CABG had worse outcomes compared to their White counterparts. Further studies are needed to confirm these findings and investigate potential underlying causes.
    Full-text · Article · Dec 2013 · BMC Cardiovascular Disorders
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    ABSTRACT: The purpose of this study was to compare baseline characteristics and medium-term prognosis in South Asian and Caucasian patients undergoing percutaneous coronary intervention (PCI). It is unclear whether South Asians undergoing PCI have worse outcomes than Caucasians. We performed a retrospective analysis of 279,256 patients undergoing PCI from 2004 to 2011 from the British Cardiovascular Intervention Society national database, of whom 259,318 (92.9%) were Caucasian and 19,938 (7.1%) were South Asian (South Asian includes patients of Pakistani, Indian, Bangladeshi, or Sri Lankan ethnic origin). The main outcome measures were in-hospital major adverse cardiac and cerebrovascular events and all-cause mortality during a median follow-up of 2.8 years (interquartile range: 1.5 to 4.5 years). South Asians were younger (59.69 ± 0.27 years vs. 64.69 ± 0.13 years, p > 0.0001); more burdened by cardiovascular risk factors, particularly diabetes mellitus (42.1 ± 1.2% vs. 15.4 ± 0.4%, p > 0.0001); and more likely to have multivessel coronary disease than Caucasians. In-hospital rates of major adverse cardiac and cerebrovascular events were similar for South Asians and Caucasians (3.5% vs. 2.8%, p = 0.40). Unadjusted Kaplan-Meier estimates of all-cause mortality showed better survival for South Asians compared with Caucasians, after PCI for either acute myocardial infarction or angina. Age-adjusted analysis revealed increased mortality (hazard ratio: 1.24; 95% confidence interval: 1.18 to 1.30), but after adjustment for the substantial variation in baseline risk factors including diabetes, there was no significant difference between South Asians and Caucasians (hazard ratio: 0.99; 95% confidence interval: 0.94 to 1.05). In this large, contemporary cohort of patients treated by PCI, South Asians were younger but had more extensive disease and major risk factors, particularly diabetes. However, after correcting for these differences, in-hospital and medium-term mortality of South Asians was no worse than that of Caucasians. This suggests that in South Asians, the high prevalence of diabetes exerts an adverse influence on mortality, but ethnicity itself is not an independent predictor of outcome.
    Preview · Article · Apr 2014 · JACC. Cardiovascular Interventions
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    ABSTRACT: People of South Asian (SA) descent are particularly susceptible to acute coronary syndromes (ACS). Yet, little information exists regarding their overall prognosis. The purpose of this study was to compare short and long-term clinical outcomes of SA and European Canadians admitted with an ACS. Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry, 63,393 patients with ACS were reviewed (January 1999 –Mar 2012). After excluding Chinese patients, 1825 SAs were compared to 60,791 European Canadians. Both groups were propensity matched and outcomes were compared. Adjustment was performed using a 3:1 propensity matching technique. Adjusted 30-day and 1-year mortality were similar between SA and European patients with ACS (2.6% vs. 2.7%, p=0.93; 5.0% vs. 4.8%, p=0.75). Repeat angiography did not differ (9.9% vs. 9.2%, p=0.35) yet repeat revascularization within 1 year was higher in SA patients (9.8% vs. 7.6%, p<0.01). Improved long-term survival (median 64 months, interquartile range [IQR] 66 months]) was noted with SA patients (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.71-0.95). In particular, long-term survival was observed in SA patients receiving CABG (HR 0.75, 95% CI 0.52-1.08) and PCI (HR 0.75, 95% CI 0.59-0.96). In conclusion, SA patients treated with revascularization appear to have improved long-term survival after ACS, compared to European Canadians. As such, clinicians should be cognitive of ethnic-based outcomes when determining therapeutic strategies in patient management.
    Full-text · Article · Aug 2014 · The American Journal of Cardiology
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