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Coronary artery size and disease in UK South Asian and Caucasian men
Dlear Zindrou1, Kenneth M Taylor, Jens Peder Bagger
1Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom.
Insights
Coronary artery size and disease severity did not differ between South Asian and Caucasian men undergoing coronary artery bypass grafting (CABG). This study found no evidence that smaller coronary arteries contribute to higher CABG mortality rates in South Asian populations.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Ethnic Disparities in Healthcare
Background:
- South Asian patients in the UK exhibit higher mortality rates following coronary artery bypass grafting (CABG) compared to Caucasian patients.
- Previous research suggested that smaller coronary artery size in South Asians might contribute to poorer outcomes after CABG.
- This study investigates the potential role of coronary artery dimensions in observed ethnic differences in CABG outcomes.
Purpose of the Study:
- To quantitatively compare coronary artery size between matched South Asian and Caucasian men undergoing their first CABG.
- To assess and compare the prevalence and severity of coronary artery disease (stenosis) between these ethnic groups.
- To determine if differences in coronary artery anatomy explain the disparity in CABG mortality rates.
Main Methods:
- Coronary arteriograms from 53 first-generation South Asian and Caucasian men were analyzed.
- Patients were rigorously matched for age, height, weight, BMI, and body surface area, with strict exclusion criteria (no prior MI, diabetes, etc.).
- Quantitative coronary angiography (QCA) was used in a blinded manner to measure coronary artery diameters and significant stenoses (≥50%).
Main Results:
- No significant differences were found in the diameters of the left main stem, left anterior descending, circumflex, or right coronary arteries between South Asian and Caucasian men.
- The number of significant coronary artery stenoses (≥50% diameter reduction) was comparable between the two ethnic groups.
- Bypass and cross-clamp times, as well as adverse outcomes including mortality (one death in each group), did not differ significantly.
Conclusions:
- Proximal coronary artery size does not differ between matched South Asian and Caucasian men when strict inclusion/exclusion criteria are applied.
- The number of significant coronary stenoses is also similar between these matched ethnic groups.
- These findings suggest that differences in proximal coronary artery size or disease burden do not account for the observed disparities in CABG outcomes between South Asian and Caucasian patients.
Objective:
South Asian patients in the UK have a higher mortality rate after coronary artery bypass grafting (CABG) than Caucasian patients. As coronary artery size has been shown to correlate to outcome from bypass grafting, it has been suggested that smaller coronary arteries in South Asians as compared to Caucasians could contribute to a poorer outcome in the Asian population. We aimed to measure coronary artery size and disease in matched South Asian and Caucasian men undergoing first time coronary artery bypass grafting.
Methods:
Coronary arteriograms from 53 matched first generation South Asian and Caucasian men were examined. The patients had no history of myocardial infarction, coronary revascularisation, familial dyslipidaemia, diabetes or renal disease. They were individually matched for age, height, weight, body mass index and body surface area. Thereafter, coronary artery diameters and significant (> or =50%) diameter stenoses were measured in a blinded fashion using quantitative coronary angiography (QCA).
Results:
In South Asian men, diameters of the left main stem (LMS) and the proximal left anterior descending, the circumflex and the right coronary arteries were 4.6+/-0.9 mm, 3.5+/-0.8 mm, 3.4+/-0.8 mm and 3.5+/-0.8 mm, respectively. The corresponding arterial diameters among Caucasian men (4.5+/-0.9 mm, 3.5+/-0.7 mm, 3.5+/-0.8 mm and 3.8+/-0.8 mm) did not differ from those in South Asians. There was no difference in the number of significant coronary artery stenoses between the two groups and no difference in bypass and cross-clamp times or in adverse outcome (one from each group died after coronary artery bypass grafting).
Conclusion:
Proximal coronary artery size and number of significant coronary stenoses did not differ between matched pairs of South Asian and Caucasian men using strict inclusion/exclusion criteria.
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