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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

Cox regression survival curves for up to 900 days of follow-up stratified by ethnicity.Cox regression survival curves for up to 900 days of follow-up stratified by ethnicity. The survival curves are adjusted for age, sex, SYNTAX score and diabetes. The left panel displays the stable CAD patients, the right panel the STEMI patients. No significant ethnic differences were found among stable CAD patients. Among the STEMI patients, mortality was significantly higher in Malays (HR 5.8) and Indians (HR 7.2) as compared to Caucasians.
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pone.0131977.g002: Cox regression survival curves for up to 900 days of follow-up stratified by ethnicity.Cox regression survival curves for up to 900 days of follow-up stratified by ethnicity. The survival curves are adjusted for age, sex, SYNTAX score and diabetes. The left panel displays the stable CAD patients, the right panel the STEMI patients. No significant ethnic differences were found among stable CAD patients. Among the STEMI patients, mortality was significantly higher in Malays (HR 5.8) and Indians (HR 7.2) as compared to Caucasians.

Mentions: In patients with stable CAD, unadjusted all-cause mortality rates did not significantly differ between the four ethnic groups (Fig 2, left panel). Among STEMI patients, however, all-cause mortality was highest in Malays, reaching 11% at one year (p = 0.053 for difference among the four ethnic groups).


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)

Cox regression survival curves for up to 900 days of follow-up stratified by ethnicity.Cox regression survival curves for up to 900 days of follow-up stratified by ethnicity. The survival curves are adjusted for age, sex, SYNTAX score and diabetes. The left panel displays the stable CAD patients, the right panel the STEMI patients. No significant ethnic differences were found among stable CAD patients. Among the STEMI patients, mortality was significantly higher in Malays (HR 5.8) and Indians (HR 7.2) as compared to Caucasians.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0131977.g002: Cox regression survival curves for up to 900 days of follow-up stratified by ethnicity.Cox regression survival curves for up to 900 days of follow-up stratified by ethnicity. The survival curves are adjusted for age, sex, SYNTAX score and diabetes. The left panel displays the stable CAD patients, the right panel the STEMI patients. No significant ethnic differences were found among stable CAD patients. Among the STEMI patients, mortality was significantly higher in Malays (HR 5.8) and Indians (HR 7.2) as compared to Caucasians.
Mentions: In patients with stable CAD, unadjusted all-cause mortality rates did not significantly differ between the four ethnic groups (Fig 2, left panel). Among STEMI patients, however, all-cause mortality was highest in Malays, reaching 11% at one year (p = 0.053 for difference among the four ethnic groups).

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