Abstract
BackgroundLittle is known on whether there are ethnic differences in outcomes following percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) after acute myocardial infarction (AMI). We compared 30-day and long-term mortality, recurrent AMI, and congestive heart failure in South Asian, Chinese and White patients with AMI who underwent PCI and CABG.MethodsHospital administrative data in British Columbia (BC), Canada were linked to the BC Cardiac Registry to identify all patients with AMI who underwent PCI (n = 4729) or CABG (n = 1687) (1999–2003). Ethnicity was determined from validated surname algorithms. Logistic regression for 30-day mortality and Cox proportional-hazards models were adjusted for age, sex, socio-economic status, severity of coronary disease, comorbid conditions, time from AMI to a revascularization procedure and distance to the nearest hospital.ResultsFollowing PCI, Chinese had higher short-term mortality (Odds Ratio (OR): 2.36, 95% CI: 1.12-5.00; p = 0.02), and South Asians had a higher risk for recurrent AMI (OR: 1.34, 95% CI: 1.08-1.67, p = 0.007) and heart failure (OR 1.81, 95% CI: 1.00-3.29, p = 0.05) compared to White patients. Risk of heart failure was higher in South Asian patients who underwent CABG compared to White patients (OR (95% CI) = 2.06 (0.92-4.61), p = 0.08). There were no significant differences in mortality following CABG between groups.ConclusionsChinese and South Asian patients with AMI and PCI or CABG had worse outcomes compared to their White counterparts. Further studies are needed to confirm these findings and investigate potential underlying causes.
Highlights
Little is known on whether there are ethnic differences in outcomes following percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) after acute myocardial infarction (AMI)
Among studies exploring the ethnic differences in fatal cardiac outcomes following CABG, some studies reported higher mortality in South Asian compared to White patients [10,11,12], while others observed no such difference [13]
1687 patients underwent CABG within one year of AMI out of which 2.6% were Chinese, 8.1% South Asian and 89.3% were White patients. Among those who underwent PCI (Table 1), South Asian patients were younger at the time of AMI presentation compared to Chinese and White patients
Summary
Little is known on whether there are ethnic differences in outcomes following percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) after acute myocardial infarction (AMI). Among studies exploring the ethnic differences in fatal cardiac outcomes following CABG, some studies reported higher mortality in South Asian compared to White patients [10,11,12], while others observed no such difference [13]. These studies are limited by lack of adjustment for differences in baseline prognostic characteristics, some by small sample sizes, and the effectiveness of revascularization is known to differ between AMI populations and those with stable coronary artery disease [2,14]. The objective of this analysis was to evaluate ethnic differences in fatal and non-fatal outcomes following PCI and CABG in Chinese, South Asian, and White patients who have suffered acute myocardial infarction (AMI) while controlling the analyses for potential confounders such as socio-demographics, severity of coronary artery disease, and presence of comorbid conditions
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