Differences Between Asian and White Outcomes Following PCI
Differences Between Asian and White Outcomes Following PCI
Aims: 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).
Methods: 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.
Results: 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].
Conclusions: 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.
There are significant differences between South Asian (SA) and White European (WE) patients presenting with coronary artery disease (CAD) despite risk factors for developing CAD being similar between the two ethnic groups. Within SAs, the prevalence of CAD and rate of cardiovascular mortality is significantly higher than their WEs counterparts. Furthermore, SAs tend to have an early onset of increased CAD risk.
Patients with symptomatic CAD are commonly managed with percutaneous coronary intervention (PCI), which is performed for symptomatic relief, ideally for patients on maximal medical therapy and in acute coronary syndromes, for additional prognostic benefit. A differential access to coronary angiography and revascularisation procedures has previously been reported among SA patients, although no difference was observed between British SAs and WEs in the time from onset of symptoms to referral for coronary angiography. It is not known whether there is a difference in outcomes between SA and WE in those offered PCI.
The aim of the present study was to compare long-term target lesion revascularisation (TLR) and all-cause mortality outcomes following PCI, between patients of SA and WE ethnic origin.
Abstract and Introduction
Abstract
Aims: 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).
Methods: 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.
Results: 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].
Conclusions: 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.
Introduction
There are significant differences between South Asian (SA) and White European (WE) patients presenting with coronary artery disease (CAD) despite risk factors for developing CAD being similar between the two ethnic groups. Within SAs, the prevalence of CAD and rate of cardiovascular mortality is significantly higher than their WEs counterparts. Furthermore, SAs tend to have an early onset of increased CAD risk.
Patients with symptomatic CAD are commonly managed with percutaneous coronary intervention (PCI), which is performed for symptomatic relief, ideally for patients on maximal medical therapy and in acute coronary syndromes, for additional prognostic benefit. A differential access to coronary angiography and revascularisation procedures has previously been reported among SA patients, although no difference was observed between British SAs and WEs in the time from onset of symptoms to referral for coronary angiography. It is not known whether there is a difference in outcomes between SA and WE in those offered PCI.
The aim of the present study was to compare long-term target lesion revascularisation (TLR) and all-cause mortality outcomes following PCI, between patients of SA and WE ethnic origin.
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