Short-Term Clinical Outcomes After Percutaneous Coronary Intervention Among Culturally and Linguistically Diverse...

We aimed to evaluate the effect of culturally and linguistically diverse (CALD) status on clinical outcome as measured by 30-day major adverse cardiac and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI).

This observational cohort study involved analysis of data from a high-volume tertiary centre in Melbourne, Australia. Adults who underwent PCI at a tertiary health service in Melbourne, Australia (January 2014-December 2021), were stratified into CALD (those born in non-English-speaking countries and/or whose primary language at home is not English) and non-CALD status. The main outcome measures were in-hospital and 30-day MACCE (composite of new heart failure, myocardial infarction, stent thrombosis, major bleeding, stroke, rehospitalisation, and mortality).

Compared to non-CALD (n=3,301, 51%), CALD patients (n=3,112, 49%) were older (mean age 65.2 vs. 61.5 years), more likely to be on medication for type 2 diabetes mellitus (33.5% vs 21.7%), had prior coronary artery bypass grafting (5.5% vs 3.7%) and were on dialysis (2.2% vs 1.0%; all p<0.001). CALD patients presented less frequently with acute coronary syndromes (58.7% vs 65.8%; p<0.001) but had increased rates of multivessel disease (8.9% vs 6.9%; p=0.004). In the ST-elevation myocardial infarction subgroup, CALD patients had lower pre-hospital notification rates (13.1% vs 20.7%) and longer symptom to PCI time (599 vs 420 minutes; both p<0.001). At 30 days, CALD patients had higher rates of rehospitalisation (13.9% vs 11.9%) and major bleeding (0.5% vs 0.1%; both p=0.05) but not overall MACCE (5.0 vs. 5.9%; p=0.12) or mortality (2.8% vs. 3.3%; p=0.28).

Despite higher rates of co-morbidities, re-hospitalisation and major bleeding, CALD patients had comparable 30-day mortality compared to non-CALD patients in contemporary systems of care. These data suggest that evolving changes within care network tailored to CALD patient needs might be beneficial and require further prospective studies.