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Case fatality rates for South Asian and Caucasian patients show no difference 2.5 years after percutaneous coronary intervention
  1. D A Jones1,2,3,
  2. K S Rathod1,
  3. N Sekhri1,
  4. C Junghans1,
  5. S Gallagher1,
  6. M T Rothman1,
  7. S Mohiddin1,2,3,
  8. A Kapur1,3,
  9. C Knight1,3,
  10. A Archbold1,3,
  11. A K Jain1,3,
  12. P G Mills1,3,
  13. R Uppal1,2,3,
  14. A Mathur1,2,3,
  15. A D Timmis1,2,3,
  16. A Wragg1,2,3
  1. 1Department of Cardiology, Barts and the London NHS Trust, London, UK
  2. 2Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary and Westfield University, London, UK
  3. 3NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK
  1. Correspondence to Dr A Wragg, Department of Cardiology, London Chest Hospital, Bethnal Green, E2 9JX London, UK; Andrew.wragg{at}bartsandthelondon.nhs.uk

Abstract

Objective To compare short and medium-term prognosis in South Asian and Caucasian patients undergoing percutaneous coronary intervention (PCI) to determine if there are ethnic differences in case death rates.

Design Retrospective cohort study.

Setting A cardiology referral centre in east London.

Patients 9771 patients who underwent PCI from October 2003 to December 2007 of whom 7966 (81.5%) were Caucasian and 1805 (18.5%) were South Asian.

Main outcome measures In-hospital major adverse cardiac events (MACE; death, myocardial infarction, stroke and target vessel revascularisation), subsequent revascularisation rates (PCI and coronary artery bypass grafting; CABG) and all-cause mortality during a median follow-up of 2.5 years (range 1.5–3.6 years).

Results South Asian patients were younger than Caucasian patients (59.69±0.27 vs 64.69±0.13 years, p<0.0001), and more burdened by cardiovascular risk factors, particularly type II diabetes mellitus (45.9%±1.2% vs 15.7%±0.4%, p<0.0001). The in-hospital rates of MACE were similar for South Asians and Caucasians (3.5% vs 2.8%, p=0.40). South Asians had higher rates of clinically driven PCI for restenosis and subsequent CABG, although Kaplan–Meier estimates of all-cause mortality showed no significant differences; this was regardless of whether PCI was performed post-acute coronary syndrome or as an elective procedure. The adjusted hazard of death for South Asians compared with Caucasians was 1.00 (95% CI 0.81 to 1.23).

Conclusion In this large PCI cohort, the in-hospital and longer-term mortality of South Asians appeared no worse than that of Caucasians. South Asians had higher rates of restenosis and CABG during follow-up. Data suggest that the excess coronary mortality for South Asians compared with Caucasians is not explained by differences in case-fatality rates.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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