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Comorbidities and Ventricular Dysfunction Drive Excess Mid-Term Morbidity in an Indigenous Australian Coronary

Paul D Wiemers1, Lucy Marney2, Nicole White3

  • 1Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Qld, Australia; University of Queensland School of Medicine, Brisbane, Qld, Australia; Royal Brisbane & Women's Hospital, Herston, Qld, Australia.

Heart, Lung & Circulation
|May 31, 2018
PubMed

Insights

Indigenous Australians undergoing coronary artery bypass grafting (CABG) experienced twice the rate of major adverse cardiac or cerebrovascular events (MACCE) compared to non-Indigenous patients. Comorbidities likely contribute to these poorer outcomes in Indigenous populations.

Area of Science:

  • Cardiovascular Surgery
  • Indigenous Health
  • Health Outcomes Research

Background:

  • Limited data exists on long-term morbidity outcomes for Indigenous Australian patients after coronary artery bypass grafting (CABG).
  • Comparative data on re-infarction, stroke, and reintervention rates are lacking for this population.
  • Outcome data following percutaneous coronary intervention (PCI) in Indigenous Australians is also scarce.

Purpose of the Study:

  • To address the knowledge gap regarding long-term morbidity outcomes in Indigenous Australian patients undergoing CABG.
  • To compare mid-term major adverse cardiac or cerebrovascular events (MACCE) rates between Indigenous and non-Indigenous patients post-CABG.

Main Methods:

  • A single-center cohort study was conducted at The Townsville Hospital, Australia.
  • Included 350 consecutive patients undergoing isolated CABG between 2008-2010.
  • Indigenous Australian patients comprised 20.9% (73/350) of the cohort; mid-term follow-up (mean 38.9 months) assessed MACCE.

Main Results:

  • The incidence of MACCE was approximately double in Indigenous Australian patients (36.7%) versus non-Indigenous patients (18.6%) at mid-term follow-up (p=0.005).
  • After adjusting for preoperative and operative factors, Indigenous Australian status was not significantly associated with MACCE (AOR 1.578).
  • Significant predictors of MACCE included renal impairment (AOR 2.198) and moderate-to-severe left ventricular impairment (AOR 3.697).

Conclusions:

  • Indigenous Australians undergoing CABG experience a higher rate of MACCE in the longer term.
  • High prevalence of comorbidities within the Indigenous Australian population is likely a key factor contributing to these adverse outcomes.
  • Further research and targeted interventions are needed to improve cardiovascular surgical outcomes for Indigenous Australians.
Abstract

Keywords:
Coronary artery bypass graftingCoronary artery diseaseCoronary artery disease risk factorsIndigenous Australians

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