Intravascular Ultrasound Comparison of Left Main Coronary Artery Disease Between White and Asian Patients

Abstract

We assessed the ethnic differences in coronary atherosclerosis lesion morphology between white and Asian patients. Our hypothesis was that left main coronary artery (LMCA) disease was more focal and less complex in Asian than in Western white patients. We studied 99 Asian patients (Japan and South Korea) and 99 matched control United States white patients with a stable clinical presentation and >30% LMCA angiographic diameter stenosis by visual estimation. The matching parameters included age, gender, and diabetes mellitus. The vessel and lumen areas and calcium arc were analyzed every 0.5 mm and normalized for analysis length. Overall, 75.1% of the patients were men and 34.1% had diabetes. The patient age was 68.0 ± 10 years, with no differences between the Asian and white patients. The Asian patients had a lower prevalence of hyperlipidemia than the white patients (41.4% vs 81.8%; p <0.0001) and were smaller in size, and the white patients were more obese (body mass index 23.7 ± 2.6 vs 27.6 ± 4.1 kg/m(2), p <0.0001). The Asian patients had a smaller lumen area (5.2 ± 1.8 vs 6.2 ± 14 mm(2); p <0.0001), larger vessel area (20.0 ± 4.9 vs 18.4 ± 4.4 mm(2); p <0.0001), and larger plaque burden (72 ± 10 vs 64 ± 12%: p <0.0001) at the minimum lumen site and over the entire LMCA length. The white patients had more calcification, whether assessed by the maximum arc (82° ± 74° vs 49° ± 45°; p <0.0001) or total length (3.6 ± 3.2 vs 2.1 ± 2.1 mm; p <0.0001). In conclusion, after matching well-known risk factors, there appeared to be ethnic differences in coronary atherosclerosis morphology between Asian and white patients, at least as it affected LMCA morphology.