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. Methods (2) – Database 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

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 Country of origin PTCA Number TOTAL3629 England2593 (428) (South Asia)(290) Pakistan158 (20) Malta146 India132 (16) Gibraltar86 Ireland73 Cyprus66 Iran46 (3) Greece32 Egypt27 Poland24 Dominican Republic 22

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

11. Results (4) - All Patients (n=3064) Age (SD)59.1 years (10.2) Males78.8% (2450) Diseased vessels (SD)1.41 (0.61) Vessel Diameter (SD)2.63mm (1.10) Emergency procedure37.2% (1350)

12. Results (5) - All Patients FH of CAD52.0% (1592) Hypertension38.9% (1191) CVA1.8% (55) Diabetes13.8% (424) Cholesterol31.6% (967) Uric Acid1.5% (46) PVD7.3% (223) Smoking34.1% (1046)

13. Results (6) – Unmatched CaucasiansAsiansp-value Age (SD)60.4 (10.1)56.0 (9.56)<0.0001 Male76.1%89.8%<0.0001 Diabetes11.0%28.2%<0.0001 Uric Acid1.5%3.1%0.047 Diseased vessels 1.38 (0.61)1.49 (0.65)0.0024 Vessel width (mm) (SD) 2.66 (1.17)2.53 (0.85)0.007

14. Caucasian s Asiansp-valueIran Age (SD)60.4 (10.1)56.0 (9.56) <0.000157.6 (9.6) Male76.1%89.8%<0.000190.7% Diabetes11.0%29.4%<0.000118.6% Uric Acid1.5%3.1%0.0472.3% Diseased vessels 1.38 (0.61)1.49 (0.65) 0.00241.46 (0.7) Vessel width (mm) (SD) 2.66 (1.17)2.53 (0.85) 0.0072.65 (0.43)

15. Results (7) – Matched Pairs CaucasiansAsiansp-value Hypertension35.3%42.1%0.036 Diabetes12.4%29.4%<0.0001 Diseased vessels(SD) 1.37 (0.60)1.49 (0.66)0.012 Vessels treated (SD) 1.17 (0.67)1.28 (0.84)0.046 Vessel width (mm) (SD) 2.64 (0.67)2.53 (0.85)0.026

16. CaucasiansIranianp-value Hypertension43%20.9%0.01 Diabetes13.9%18.6%NS Vessel treated1.421.23NS Diseased vessels(SD) 1.54 (0.63)1.46 (0.7)NS Chol32.623.2NS SMK27.932.6NS FH51.239.5NS PVD11.62.3NS Emergency23.220.9NS Matched Caucasian Vs Iran

17. Results (9) – Trends in Age

18. Pakistanis Vs Indians

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

20. 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)

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

22. 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

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

24. 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

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