429 Clinical Outcomes in South Asians With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: Results from Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease Registry

Abstract

People of South Asian (SA) descent are particularly susceptible to coronary artery disease (CAD) and tend to have adverse outcomes in acute coronary syndromes (ACS). Percutaneous coronary intervention (PCI) has become a common revascularization strategy in ACS yet the implications on this high-risk population are unknown. Accordingly, we compared clinical outcomes of SA and European Canadians with ACS undergoing PCI. From the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry, 27 367 PCI-treated patients with ACS were reviewed (January 1999 - March 2010). Ethnicity was determined using validated surname selection software. Differences in one-year and long-term survival were compared between SA (n=787) and European (n=26 580) Canadian patients. As seen in the Table, South Asians are younger in age and are more likely diabetic compared to European Canadians. A strong trend towards improved survival is seen at one year with clear benefit long-term in the South Asian cohort. After propensity-matched adjustment, the relative risk of death favored South Asians compared to Europeans at one-year (HR 0.50, 95% CI 0.27-0.91, p<0.02) and long-term (HR 0.61, 95% CI 0.44-0.83, p=0.002). Differences in one-year mortality were seen in SA with bare metal stents (BMS) versus drug eluting stents (DES) (2.1% versus 0.7%), as well as in Europeans with BMS versus DES (3.8% versus 2.8%) (p=0.06). Similar results were seen with one-year repeat revascularization in SA with BMS versus DES (14.2% versus 9.9%) as well as Europeans with BMS versus DES (14.6% versus 8.5%) (p=0.001).Tabled 1 Despite prior work demonstrating lower quality of life in SA patients with coronary disease, our results showed an improvement in survival amongst SA receiving PCI following an ACS event. Additionally, DES offers benefit in both ethnic groups. Further research is required to understand the apparent disconnect between survival and quality of life in SA patients.