Abstract P28: Comparison of Short- and Long-Term Mortality Between Older Asian and White Patients with Non–ST-Elevation Myocardial Infarction: Findings from CRUSADE-CMS Database

Abstract

Background: While previous studies have shown similar in-hospital mortality between Asian and White patients with non-ST elevation myocardial infarction (NSTEMI), little is known about their longer-term mortality differences. Methods: We linked Medicare claims data to detailed clinical data for 37702 NSTEMI patients ≥65 years of age from 444 CRUSADE hospitals between 2003 and 2006 to examine longitudinal outcomes. All-cause 30-day and 1-year mortality were compared between Asian and White patients by Cox proportional hazards modeling adjusting for differences in baseline patient characteristics. Results: Compared with White patients, Asians (n= 307) were younger, more frequently had hypertension, diabetes, and renal insufficiency, and less likely to have had a prior MI or coronary revascularization. There were no significant differences in rates of cardiac catheterization (60.7% vs. 58.0%, p=0.26), PCI (32.2% vs. 31.6%, p=0.73), and CABG (9.2% vs. 8.5%, p=0.62) between Whites and Asians respectively. While the difference in risk-adjusted mortality was not statistically significant between Asian and White patients at 30-days (HR 0.70, 95% CI 0.48 - 1.01), lower 1-year mortality (adjusted HR 0.62, 95% CI 0.48 - 0.79) and 1-year mortality conditional on surviving 30 days (adjusted HR 0.56, 95% CI 0.40 - 0.78) were observed among Asians (Figure). Conclusions: While short-term outcomes were similar between Asian and White NSTEMI patients ≥65 years of age, Asians had better outcomes at 1 year. Further study is needed to determine whether more complete follow-up and use of secondary prevention strategies in Asians help to explain these long-term differences in outcome.