Hypothesis of Long-Term Outcome after Coronary Revascularization in Japanese Patients Compared to Multiethnic Groups in the US

Abstract

BackgroundEthnicity has a significant impact on coronary artery disease (CAD). This study investigated the long-term outcomes of Japanese patients undergoing revascularization compared with US patients belonging to multiple ethnic groups.Methods and ResultsWe evaluated clinical outcomes, based on ethnicity, of patients included in the Coronary Revascularization Demonstrating Outcome (CREDO-Kyoto) and the Texas (US) Heart Institute Research Database (THIRDBase) registries. For the analysis, we included 8871 patients from the CREDO-Kyoto registry (median follow-up period [FU], 3.5 years; interquartile range [IQR], 2.6–4.3) and 6717 patients from the THIRDBase registry (FU, 5.2 years; IQR, 3.8–6.5) who underwent percutaneous coronary intervention or bypass surgery. Cox proportional hazard models were constructed to compare the adjusted long-term outcomes for each ethnic group. A total of 8871 Japanese, 5170 Caucasians, 648 African-Americans, 817 Hispanics, and 82 Asian-Americans were identified. When adjusted, Japanese patients had significantly better outcomes than US patients, classified by ethnicity (Caucasians: hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.35–1.79; Hispanics: HR, 1.53; 95% CI, 1.22–1.93; African-Americans: HR, 2.03; 95% CI, 1.62–2.56), except for Asian-Americans (HR, 0.84; 95% CI. 0.38–1.89) who had outcomes similar to Japanese patients.ConclusionOur findings indicate better survival outcomes in re-vascularized Japanese CAD patients compared to major ethnic groups in the US, including Caucasian, Hispanic, and African-American CAD patients. The characteristics and outcomes of Japanese CAD patients were similar to those of Asian-Americans, despite the sample size limitations in the US dataset.

Prognostic impact of reducing myocardial ischemia identified using ECG-gated myocardial perfusion SPECT in Japanese patients with coronary artery disease: J-ACCESS 4 study

“…The cardiac event rate was around 3% for cardiac death and 5% for MI [16]. On the other hand, others have reported that Japanese patients have a better prognosis after cardiovascular events compared with patients in North America [16,17]. The annual event rates of death and MI are about 2% in Japanese patients after coronary stent implantation in [18].…”

<p>Metabolic Syndrome for Cardiovascular Disease Morbidity and Mortality Among General Japanese People: A Mini Review</p>

“…10 Most studies might not have had a sufficiently long period to observe the development of CVD outcomes, especially mortality, as long-term care for a long lifespan is provided to Japanese people with CVD. [11][12][13] In addition, the confounding factors in the adjusted analyses differed among the reviewed studies.…”

“…10 The healthcare system of Japan (i.e., a freeaccess system to any medical institutions providing intensive therapy and close follow-up for CVD patients) may be a reason for such a low CVD mortality. [11][12][13] The characteristics of obesity and CVD in Japan are different from those in Western countries; thus, the relevance of MetS on CVD can be still discussed among Japanese people. [7][8][9][10]14 The summary of data specific to Japanese people can give an insight into the understanding of MetS on risk management of CVD.…”

Comorbidity in Coronary Heart Disease Patients Undergoing Bypass Grafting: An Experience of Two Surgery Centers

“…Последний факт подтверждает и мультиэтни-ческое крупное регистровое исследование Кредо-Киото, которое включало 15580 пациентов, подверг-шихся КШ или ЧКВ. Так, самый низкий процент больных диабетом в данном регистре отмечен в евро-пеоидной (26,9%) и японской (39%) группах, а самый высокий процент -в африкано-американской (44%) и испанской (49,5%) этнических группах [50].…”