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St. Mary’s Hospital PTCA Registry

Trends and Characteristics of Caucasian, Indian & Pakistani Patients Undergoing Coronary Angioplasty. St. Mary’s Hospital PTCA Registry. Introduction. Asians are thought to have higher risk of complications and poorer outcome after PTCA

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St. Mary’s Hospital PTCA Registry

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  1. Trends and Characteristics of Caucasian, Indian & Pakistani Patients Undergoing Coronary Angioplasty • St. Mary’s Hospital PTCA Registry

  2. Introduction • Asians are thought to have higher risk of complications and poorer outcome after PTCA • However, there is no data comparing the characteristics of Asians to that of Caucasians undergoing PTCA • There is also no data comparing the characteristic differences that may exist between South Asian originating from different countries or races • Coronary Artery Bypass Grafting (CABG) • Percutaneous Transluminal Coronary Angioplasty (PTCA)

  3. Aims This study examines the differences in risk factors and general trends between Caucasians and Asians patients and between Indians and Pakistanis to determine factors that may explain differences in outcome following PTCA

  4. Methods (1) • Data sources: • Database: PTCA data was prospectively collected on a dedicated database from 1986 to 1996 • Data was Validated using • Catheter lab registry notes • Radiography registry notes • Hospital PAZ system • Patient notes

  5. Variables on database Date of birth Gender Date of operation Ethnic origin Lesion site & size Number of vessels diseased & treated Emergency presentation FHx of CAD History of: Hypertension Stroke Diabetes Cholesterol Uric acid PVD Smoking Methods (2) – Database

  6. Statistics (1) Continuous Data • Unpaired t-test • Unmatched patients • eg. Age at procedure, vessel diameter • Paired t-test • Matched pairs (age/sex/year of procedure) • Mann-Whitney test • Parametric - variances unequal

  7. Statistics (2)Categorical Data • Chi-squared test • Unmatched patients • eg. Diabetes, smoking • McNemar test • Matched pairs

  8. Results(1) - Patient Population • 3629 entries (3064 patients) • 565 repeats • 2171 Caucasian patients • 254 Asians patients

  9. Results (2) – Population

  10. Results (3) - Cases Per Year Data for 1996 is only available for the first 6 months

  11. Results (4) - All Patients

  12. Results (5) - All Patients

  13. Results (6) – Unmatched

  14. Results (7) – Matched Pairs

  15. Matched Caucasian Vs Iran

  16. Results (9) – Trends in Age

  17. Pakistanis Vs Indians

  18. Discussion (1) • This is one of the first studies looking at ethnic variation in patients attending for coronary angioplasty

  19. Discussion (2) - Asians • Younger age • More vessel disease • Hughes et al.(MI - 5.5 years earlier, 3VD) • Smaller vessels • Dhawan & Bray (quantative angiography) • Diabetes (29% vs. 11%) • McKeigue et al. (19% vs 4%, known CAD)

  20. Discussion (3)Indians Vs. Pakistanis • Pakistanis • Hypertension • Cholesterol • Emergency • Indians • FH of CAD • More vessel disease (1.68 vs. 1.33)

  21. Discussion (4)Indians Vs. Pakistanis Inherited factors may have greater role in determining the extent of CAD and factors other than raised cholesterol and hypertension may be involved

  22. Limitations • Ensuring accuracy of database • Long-term outcome study • Coronary artery size • Changing acceptable level

  23. Conclusions • Asians patients have significantly greater risk factors than Caucasians • Pakistanis exhibit more risk factors, but Indians have more widespread disease • Asians should not be considered a homogenous group

  24. References • Bhopal R et al. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ 1999;319:215-220 • Dhawan J, Bray CL. Are Asian coronary arteries smaller than Caucasian? A study on angiographic coronary artery size estimation during life. International Journal of Cardiology 1995;49:267-269 • Dhawan J, Bray CL, Warburton R, Ghambhir DS, Morris J. Insulin resistance, high prevalence of diabetes, and cardiovascular risk in immigrant Asians. Genetic or environmental effect? British Heart Journal 1994;72:413-421 • Farooqi IS, Beevers G, Lip GYH. Insulin resistance, high prevalence of diabetes, and cardiovascular risk in immigrant Asians [letter]. British Heart Journal 1993;73:584 • Hughes LO, Raval U, Raferty EB. First myocardial infarctions in Asians and white men. BMJ 1989 May 20;298:1345-1350 • Khattar RS, Swales JD, Senior R, Lahiri A. Racial variation in cardiovascular morbidity and mortality in essential hypertension. Heart 2000;83:267-271 • McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991;337:382-386

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