Invasive cardiac procedure use and mortality among South Asian and Chinese Canadians with coronary artery disease

Quan, Hude; Khan, Nadia; Li, Bing; Humphries, Karin H.; Faris, Peter; Galbraith, P. Diane; Graham, Michelle M.; Knudtson, Merril L.; Ghali, William A.

doi:10.1016/s0828-282x(10)70414-1

Cited by 18 publications

(20 citation statements)

References 20 publications

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“…Among patients with end-stage renal disease, Hammelgarn et al 28 found Chinese patients to have better survival after initiating dialysis treatment compared with white patients. Similarly, among patients who underwent coronary angiography, Quan et al 29 found that Chinese patients were slightly less likely to undergo PCI or coronary artery bypass graft but had similar long-term mortality as whites. However, both those studies were focused on select populations undergoing specific procedures, which may have been subject to referral bias.…”

Section: Discussionmentioning

confidence: 94%

Ethnic differences in 1-year mortality among patients hospitalised with heart failure

Kaul

McAlister

Grover

et al. 2011

Heart

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Section: Discussionmentioning

confidence: 94%

Ethnic differences in 1-year mortality among patients hospitalised with heart failure

Kaul

McAlister

Grover

et al. 2011

Heart

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“…7,27,55-57 However, short-7-9,27,32,55,58 and long-term mortality 7,27,31,32,34,51 after MI appeared to be similar among South Asian and white people (Appendix 3).…”

Section: Diagnosis Management and Outcomesmentioning

confidence: 97%

“…were more likely to have hypertension compared with white people 3,4,9,14,27,28,31,32,[34][35][36]41,44 (OR 1.11, 95% CI 1.02 to 1.22, p = 0.02).…”

Section: Cmaj Openmentioning

confidence: 99%

“…Once in hospital, however, South Asian people and white people had similar access to diagnostic procedures and interventions 2,7,8,27 for CVD, although there was some practice and outcome variation between provinces (Appendix 3). Following hospital admission for acute coronary syndrome, South Asians had higher short-term (< 1 yr) recurrent event rates, including readmission to hospital and recurrent angina, compared with white people.7,27,55-57 However, short-7-9,27,32,55,58 and long-term mortality 7,27,31,32,34,51 after MI appeared to be similar among South Asian and white people (Appendix 3). …”

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confidence: 99%

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Cardiovascular risk among South Asians living in Canada: a systematic review and meta-analysis

et al. 2014

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Background: South Asians represent about 3% of the Canadian population and have a higher burden of certain cardiovascular risk factors and cardiovascular disease (CVD) compared with white people. The objective of this study was to review the literature to compare cardiovascular risk factors and disease management practices among adult South Asian and white Canadians. Methods:We searched MEDLINE, Embase, Cochrane and Cumulative Index to Nursing and Allied Health Literature databases from their inception through Feb. 17, 2014 and the reference lists of the selected articles. English-language studies of interventions and observational studies of biological mechanisms underlying CVD risk in South Asians conducted in Canada were eligible for inclusion. Where appropriate, we used random-effects meta-analyses to integrate results comparing the CVD risk profiles of South Asian and white Canadians. Results:We included 50 articles (n = 5 805 313 individuals) in this review. Compared with white Canadians, South Asian Canadians had a higher prevalence and incidence of CVD, an increased prevalence of diabetes (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.81 to 2.80, p < 0.001) and hypertension (OR 1.11, 95% CI 1.02 to 1.22, p = 0.02), lower high-density lipoprotein cholesterol levels (mean difference -0.19 mmol/L, 95% CI -0.25 to -0.13 mmol/L, p < 0.001) and a higher percentage of body fat (men: absolute mean difference 3.23%, 95% CI 0.83% to 5.62%, p = 0.008; women: absolute mean difference 4.09%, 95% CI 3.46% to 4.72%, p < 0.001). South Asian people are also more sedentary, consume higher levels of carbohydrates and are less likely to smoke tobacco (OR 0.38, 95% CI 0.24 to 0.60, p < 0.001]) than white Canadians. No differences in access to diagnostic tests, outcomes following cardiovascular surgery or use of cardiac rehabilitation programs were apparent.Interpretation: Compared with white people, South Asian people living in Canada have a higher prevalence and incidence of CVD and possess a unique cardiovascular risk profile. Abstract E184CMAJ OPEN, 2(3) Research CMAJ OPEN Methods Search strategy and selectionIn consultation with an information specialist, we developed search terms for MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Registry databases to identify human studies reporting associations among South Asian ethnicity, CVD risk factors and CVD. The initial search (conducted May 21, 2013) captured articles from database inception through May 2013; at the request of the CMAJ Open editors, the search was updated through to Feb. 17, 2014 (Appendix 1, available online at www.cmajopen.ca/content/2/3/E183/suppl/DC1). Three investigators (A.R., R.dS. and S.S.A.) each screened a third of the titles and abstracts of the studies identified in the electronic search to arrive at a list of articles for full-text review. The same 3 reviewers assessed the eligibility of these fulltext articles. Disagreements were resolved by discussion and consensus. Studies that were not p...

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“…A large study involving the Society of Thoracic Surgeons (STS) database showed that ethnicity (whites versus nonwhites) was an independent predictor of operative mortality after CABG . Quan et al investigated the use of invasive cardiac procedures and suggested that physicians may consider patient ethnicity when recommending procedures including CABG or PCI. With respect to PCI, a recent large retrospective study in the United Kingdom (n=279 256) showed that ethnicity (SA versus whites) was not an independent predictor of mortality (adjusted hazard ratio [HR] 0.99; 95% CI 0.94–1.05, median follow‐up 2.8 years); in CABG, however, the evidence has been controversial with regard to whether being SA is an independent predictor of adverse outcomes after CABG .…”

Section: Introductionmentioning

confidence: 99%

Impact of South Asian Ethnicity on Long‐Term Outcomes After Coronary Artery Bypass Grafting Surgery: A Large Population‐Based Propensity Matched Study

Deb

Austin

et al. 2016

JAHA

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BackgroundEthnicity is an important predictor of coronary artery bypass graft surgery (CABG) outcomes. South Asians (SA), one of the largest ethnic groups with a high burden of cardiovascular disease, are hypothesized to have inferior outcomes after CABG compared to other ethnic groups. Given the paucity and controversy of literature in this area, the objective of this study was to examine the impact of SA versus the general population (GP) on long‐term outcomes following CABG.Method and ResultsUsing administrative databases and a surname algorithm, 83 850 patients (SA: 2653, GP: 81 197) who underwent isolated CABG in Ontario, Canada from 1996 to 2007 were identified; mean follow‐up was 9.1±3.9 years. SA were younger (SA: 61.7±9.4, GP: 64.1±10.0 years, standardized difference=0.25) with more cardiac risk factors, including diabetes (SA: 54.1%, GP: 34.9%, standardized difference =0.40). Propensity‐score matching resulted in 2473 matched pairs between SA and GP with all baseline covariates being balanced (standardized difference <0.1). Being a SA compared to the GP was protective against freedom from major adverse cardiac and cerebrovascular events, defined by all‐cause death, myocardial infarction, stroke, or coronary reintervention: Adjusted Cox‐proportional hazard ratio 0.91, 95% CI (0.83–0.99), adjusted‐P=0.04; this was also true for freedom from all‐cause mortality: hazard ratio 0.81, 95% CI (0.72–0.91), adjusted P=0.0004. The adjusted proportion of major adverse cardiac and cerebrovascular events was lower in the SA (SA: 34.7%, GP: 37.8%, McNemar P=0.03), driven largely by all‐cause mortality (SA: 20.4%, GA: 24.3%, McNemar P=0.001).ConclusionsContrary to existing notions, our study finds that being a SA is protective with respect to freedom from long‐term major adverse cardiac and cerebrovascular events and mortality after CABG. More studies are required to corroborate and explore causal factors of these findings.

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Invasive cardiac procedure use and mortality among South Asian and Chinese Canadians with coronary artery disease

Cited by 18 publications

References 20 publications

Ethnic differences in 1-year mortality among patients hospitalised with heart failure

Ethnic differences in 1-year mortality among patients hospitalised with heart failure

Cardiovascular risk among South Asians living in Canada: a systematic review and meta-analysis

Impact of South Asian Ethnicity on Long‐Term Outcomes After Coronary Artery Bypass Grafting Surgery: A Large Population‐Based Propensity Matched Study

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