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Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients.

Gijsberts CM, Seneviratna A, Hoefer IE, Agostoni P, Rittersma SZ, Pasterkamp G, Hartman M, Pinto de Carvalho L, Richards AM, Asselbergs FW, de Kleijn DP, Chan MY - PLoS ONE (2015)

Bottom Line: Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001.Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age.Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause mortality than Caucasians, independent of SYNTAX score.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; The Netherlands Heart Institute (ICIN), Utrecht, the Netherlands.

ABSTRACT

Background: Coronary artery disease (CAD) is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic "synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery" (SYNTAX) score quantifies CAD severity and predicts outcomes. We studied CAD severity and all-cause mortality in four globally populous ethnic groups: Caucasians, Chinese, Indians and Malays.

Methods: We quantified SYNTAX scores of 1,000 multi-ethnic patients undergoing PCI in two tertiary hospitals in the Netherlands (Caucasians) and Singapore (Chinese, Indians and Malays). Within each ethnicity we studied 150 patients with stable CAD and 100 with ST-elevated myocardial infarction (STEMI). We made inter-ethnic comparisons of SYNTAX scores and all-cause mortality.

Results: Despite having a younger age (mean age Indians: 56.8 and Malays: 57.7 vs. Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001. Among STEMI patients, SYNTAX scores were highest in Chinese and Malays: 17.7 [15.9-19.5] and 18.8 [17.1-20.6] vs. 15.5 [13.5-17.4] and 12.7 [10.9-14.6] in Indians and Caucasians, p<0.001. Over a median follow-up of 709 days, 67 deaths (stable CAD: 37, STEMI: 30) occurred. Among STEMI patients, the SYNTAX score independently predicted all-cause mortality: HR 2.5 [1.7-3.8], p<0.001 for every 10-point increase. All-cause mortality was higher in Indian and Malay STEMI patients than Caucasians, independent of SYNTAX score (adjusted HR 7.2 [1.5-34.7], p=0.01 and 5.8 [1.2-27.2], p=0.02).

Conclusion: Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age. Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause mortality than Caucasians, independent of SYNTAX score.

No MeSH data available.


Related in: MedlinePlus

SYNTAX scores of stable CAD and STEMI patients, stratified by ethnicity.Panel A: SYNTAX scores of stable CAD patients (n = 150 per ethnic group). Panel B: SYNTAX scores of STEMI patients (n = 100 per ethnic group). Point estimates and error bars show the mean SYNTAX scores with 95% confidence intervals. Different transparencies present: crude mean SYNTAX scores (highly transparent), mean SYNTAX scores adjusted for age (lightly transparent) and multivariable adjusted mean SYNTAX scores (solid). P-values displayed in the figure are derived from multivariable (full model) ANCOVA, followed by Tukey post-hoc testing. The full model contains: age, body mass index, diabetes, dyslipidemia, smoking, previous PCI, previous acute coronary syndrome, peripheral arterial disease, platelet inhibitor, statin and beta-blocker use.
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pone.0131977.g001: SYNTAX scores of stable CAD and STEMI patients, stratified by ethnicity.Panel A: SYNTAX scores of stable CAD patients (n = 150 per ethnic group). Panel B: SYNTAX scores of STEMI patients (n = 100 per ethnic group). Point estimates and error bars show the mean SYNTAX scores with 95% confidence intervals. Different transparencies present: crude mean SYNTAX scores (highly transparent), mean SYNTAX scores adjusted for age (lightly transparent) and multivariable adjusted mean SYNTAX scores (solid). P-values displayed in the figure are derived from multivariable (full model) ANCOVA, followed by Tukey post-hoc testing. The full model contains: age, body mass index, diabetes, dyslipidemia, smoking, previous PCI, previous acute coronary syndrome, peripheral arterial disease, platelet inhibitor, statin and beta-blocker use.

Mentions: The crude and adjusted SYNTAX scores are depicted in Fig 1A. Crude SYNTAX scores (with 95% confidence intervals) were highest for Indians and Malays: 13.2 (12.0–14.4) and 13.5 (12.4–14.6), respectively. Age-adjusted mean SYNTAX scores for Caucasians, Chinese, Indians and Malays were 10.1 (8.9–11.2), 11.1 (10.0–12.2), 13.3 (12.2–14.4) and 13.6 (12.5–14.7). Even after multivariable adjustment, these ethnic differences in SYNTAX scores persisted: 9.4 (8.1–10.8), 11.8 (10.4–13.1), 13.4 (11.9–14.9) and 13.4 (12.0–14.8). Post-hoc testing revealed significantly lower SYNTAX scores in Caucasians when comparing with Indians (p = 0.001) or with Malays (p<0.001) in the multivariable model. Other comparisons did not reveal significant differences. The crude and adjusted SYNTAX scores are presented in Table 1.


Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients.

Gijsberts CM, Seneviratna A, Hoefer IE, Agostoni P, Rittersma SZ, Pasterkamp G, Hartman M, Pinto de Carvalho L, Richards AM, Asselbergs FW, de Kleijn DP, Chan MY - PLoS ONE (2015)

SYNTAX scores of stable CAD and STEMI patients, stratified by ethnicity.Panel A: SYNTAX scores of stable CAD patients (n = 150 per ethnic group). Panel B: SYNTAX scores of STEMI patients (n = 100 per ethnic group). Point estimates and error bars show the mean SYNTAX scores with 95% confidence intervals. Different transparencies present: crude mean SYNTAX scores (highly transparent), mean SYNTAX scores adjusted for age (lightly transparent) and multivariable adjusted mean SYNTAX scores (solid). P-values displayed in the figure are derived from multivariable (full model) ANCOVA, followed by Tukey post-hoc testing. The full model contains: age, body mass index, diabetes, dyslipidemia, smoking, previous PCI, previous acute coronary syndrome, peripheral arterial disease, platelet inhibitor, statin and beta-blocker use.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4492790&req=5

pone.0131977.g001: SYNTAX scores of stable CAD and STEMI patients, stratified by ethnicity.Panel A: SYNTAX scores of stable CAD patients (n = 150 per ethnic group). Panel B: SYNTAX scores of STEMI patients (n = 100 per ethnic group). Point estimates and error bars show the mean SYNTAX scores with 95% confidence intervals. Different transparencies present: crude mean SYNTAX scores (highly transparent), mean SYNTAX scores adjusted for age (lightly transparent) and multivariable adjusted mean SYNTAX scores (solid). P-values displayed in the figure are derived from multivariable (full model) ANCOVA, followed by Tukey post-hoc testing. The full model contains: age, body mass index, diabetes, dyslipidemia, smoking, previous PCI, previous acute coronary syndrome, peripheral arterial disease, platelet inhibitor, statin and beta-blocker use.
Mentions: The crude and adjusted SYNTAX scores are depicted in Fig 1A. Crude SYNTAX scores (with 95% confidence intervals) were highest for Indians and Malays: 13.2 (12.0–14.4) and 13.5 (12.4–14.6), respectively. Age-adjusted mean SYNTAX scores for Caucasians, Chinese, Indians and Malays were 10.1 (8.9–11.2), 11.1 (10.0–12.2), 13.3 (12.2–14.4) and 13.6 (12.5–14.7). Even after multivariable adjustment, these ethnic differences in SYNTAX scores persisted: 9.4 (8.1–10.8), 11.8 (10.4–13.1), 13.4 (11.9–14.9) and 13.4 (12.0–14.8). Post-hoc testing revealed significantly lower SYNTAX scores in Caucasians when comparing with Indians (p = 0.001) or with Malays (p<0.001) in the multivariable model. Other comparisons did not reveal significant differences. The crude and adjusted SYNTAX scores are presented in Table 1.

Bottom Line: Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001.Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age.Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause mortality than Caucasians, independent of SYNTAX score.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; The Netherlands Heart Institute (ICIN), Utrecht, the Netherlands.

ABSTRACT

Background: Coronary artery disease (CAD) is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic "synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery" (SYNTAX) score quantifies CAD severity and predicts outcomes. We studied CAD severity and all-cause mortality in four globally populous ethnic groups: Caucasians, Chinese, Indians and Malays.

Methods: We quantified SYNTAX scores of 1,000 multi-ethnic patients undergoing PCI in two tertiary hospitals in the Netherlands (Caucasians) and Singapore (Chinese, Indians and Malays). Within each ethnicity we studied 150 patients with stable CAD and 100 with ST-elevated myocardial infarction (STEMI). We made inter-ethnic comparisons of SYNTAX scores and all-cause mortality.

Results: Despite having a younger age (mean age Indians: 56.8 and Malays: 57.7 vs. Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001. Among STEMI patients, SYNTAX scores were highest in Chinese and Malays: 17.7 [15.9-19.5] and 18.8 [17.1-20.6] vs. 15.5 [13.5-17.4] and 12.7 [10.9-14.6] in Indians and Caucasians, p<0.001. Over a median follow-up of 709 days, 67 deaths (stable CAD: 37, STEMI: 30) occurred. Among STEMI patients, the SYNTAX score independently predicted all-cause mortality: HR 2.5 [1.7-3.8], p<0.001 for every 10-point increase. All-cause mortality was higher in Indian and Malay STEMI patients than Caucasians, independent of SYNTAX score (adjusted HR 7.2 [1.5-34.7], p=0.01 and 5.8 [1.2-27.2], p=0.02).

Conclusion: Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age. Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause mortality than Caucasians, independent of SYNTAX score.

No MeSH data available.


Related in: MedlinePlus