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

Abstract

BackgroundCoronary 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.MethodsWe 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.ResultsDespite 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).ConclusionAmong 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.

Incidence and predictors of target lesion failure in a multiethnic Asian population receiving the SYNERGY coronary stent: A prospective all‐comers registry

“…The greater severity of coronary artery disease in the patients of Malay descent has been reported [19]. This could explain the higher TLF rates in the Malay ethnic groups, which were observed in our registry.…”

“…The Malay ethnicity carried an increased risk of incidence (OR 2.24, P < 0.05) and time to early TLF (HR 2.11, P < 0.05). The greater severity of coronary artery disease in the patients of Malay descent has been reported . This could explain the higher TLF rates in the Malay ethnic groups, which were observed in our registry.…”

ST‐elevation myocardial infarction in a migrant population: a registry‐based study of patient treatment and outcomes

“…Alternatively, sociocultural factors, such as diet, traditional views on illness and dislocation from social networks, may also play a role. Mechanisms, such as different physiological responses to hypertension and altered patterns of atherosclerosis, have been proposed, although research is far from definitive . Although the exact mechanism for these differences is poorly understood, it is increasingly recognised that cardiovascular risk in these groups may not be appropriately estimated using current guidelines .…”

“…[13][14][15][16][17] When they do receive reperfusion, migrant patients are more likely to require coronary artery bypass grafting (CABG), which may reflect more advanced disease at time of presentation. 5,15,18 These disparities in treatment appear to persist despite adjustment for clinical, demographic, insurance and hospital characteristics. 16 migrant patients and those from a minority background.…”

Is the Syntax Score Sufficient to Assess the Risk for Patients Undergoing Elective Percutaneous Coronary Interventions?

“…Gijsberts и соавт. [11]. Всего в данное исследование было включено 1 000 пациентов после ЧКВ: у 400 из них эндоваскулярные вме-шательства выполнялись в связи с ИМ с подъе-мом ST, у 600 -в связи со стабильной стено-кардией.…”