Long-Term Survival With Revascularization in South Asians Admitted With an Acute Coronary Syndrome (from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease Registry)

Abstract

People of South Asian (SA) descent are particularly susceptible to acute coronary syndromes (ACS). Yet, little information exists regarding their overall prognosis. The purpose of this study was to compare short- and long-term clinical outcomes of SA and European Canadians admitted with an ACS. Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease registry, 63,393 patients with ACS were reviewed (January 1999 to March 2012). After excluding Chinese patients, 1,825 SAs were compared with 60,791 European Canadians. Both groups were propensity matched, and outcomes were compared. Adjustment was performed using a 3:1 propensity matching technique. Adjusted 30-day and 1-year mortality rates were similar between SA and European patients with ACS (2.6% vs 2.7%, p= 0.93; 5.0% vs 4.8%, respectively, p= 0.75). Repeat angiography did not differ (9.9% vs 9.2%, p= 0.35), yet repeat revascularization within 1year was greater in SA patients (9.8% vs 7.6%, p <0.01). Improved long-term survival (median 64months, interquartile range 66months) was noted with SA patients (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.71 to 0.95). In particular, long-term survival was observed in SA patients receiving coronary artery bypass grafting (HR 0.75, 95% CI 0.52to1.08) and percutaneous coronary intervention (HR 0.75, 95% CI 0.59 to 0.96). In conclusion, SA patients treated with revascularization appear to have improved long-term survival after ACS, compared with European Canadians. As such, clinicians should be cognitive of ethnic-based outcomes when determining therapeutic strategies in patient management.