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Schultz A, Dahl L, McGibbon E, Brownlie J, Cook C, Elbarouni B, Katz A, Nguyen T, Sawatzky JAV, Prior HJ, Sinclaire M, Throndson K, Fransoo R. Differences in coronary artery disease complexity and associations with mortality and hospital admissions among First Nations and non-First Nations patients undergoing angiography: a comparative retrospective matched cohort study. CMAJ Open 2020; 8:E685-E694. [PMID: 33139389 PMCID: PMC7608944 DOI: 10.9778/cmajo.20190171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND First Nations people are more likely than the general population to experience long-term adverse health outcomes after coronary angiography. Our aim was to quantify the extent of coronary artery disease among First Nations and non-First Nations patients undergoing angiography to investigate differences in coronary artery disease and related health disparities. METHODS We conducted a retrospective matched cohort study to compare health outcomes of First Nations and non-First Nations adult patients (> 18 yr) who underwent index angiography between Apr. 1, 2008, and Mar. 31, 2012, in Manitoba, Canada. The SYNTAX Score was used to measure and compare severity of coronary artery disease between groups. Primary outcomes of all-cause and cardiovascular mortality were compared between groups using Cox proportional hazard models adjusted by SYNTAX Score results and weighted by the inverse probability of being First Nations. Secondary outcomes included all-cause and cardiovascular-related hospital admissions. RESULTS The cohort consisted of 277 matched pairs of First Nations and non-First Nations patients undergoing angiography; the average age of patients was 56.0 (standard deviation 11.7) years. The median SYNTAX Score results and patient distributions across categories in the matched paired cohort groups were not significantly different. Although proportionally First Nations patients showed worse health outcomes, mortality risks were similar in the weighted sample, even after controlling for revascularization and SYNTAX Score results. Secondary outcomes showed that adjusted risks for hospital admission for acute myocardial infarction (adjusted hazard ratio [HR] 3.03, 95% confidence interval [CI] 1.40-6.55) and for congestive heart failure (adjusted HR 3.84, 95% CI 1.37-10.78) were significantly higher among First Nations patients in the weighted sample. INTERPRETATION The extent of coronary artery disease among matched cohort groups of First Nations and non-First Nations patients appears similar, and controlling for baseline sociodemographic characteristics, coronary artery disease risk factors and SYNTAX Score results explained higher mortality risk and most hospital admissions among First Nations patients. Although there is a need to decrease risk factors for coronary artery disease among First Nations populations, addressing individuals' behaviour without considering root causes underlying risk factors for coronary artery disease will fail to decrease health outcome disparities among First Nations patients undergoing angiography.
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Affiliation(s)
- Annette Schultz
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
| | - Lindsey Dahl
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Elizabeth McGibbon
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Jarvis Brownlie
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Catherine Cook
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Basem Elbarouni
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Alan Katz
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Thang Nguyen
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Jo-Ann V Sawatzky
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Heather J Prior
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Moneca Sinclaire
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Karen Throndson
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Randy Fransoo
- College of Nursing (Schultz, Dahl, Sawatzky, Sinclaire), Rady Faculty of Health Sciences, University of Manitoba; St. Boniface Hospital Research Centre (Schultz, Dahl, Sawatzky, Sinclaire), Winnipeg, Man.; Rankin School of Nursing, Faculty of Health Sciences (McGibbon), St. Francis Xavier University, Antigonish, NS; Department of History (Brownlie), Faculty of Arts, University of Manitoba; First Nations, Métis and Inuit Health (Cook), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Cardiac Sciences Program, St. Boniface Hospital (Elbarouni, Nguyen, Throndson); Max Rady College of Medicine (Elbarouni, Nguyen), Rady Faculty of Health Sciences, University of Manitoba; Manitoba Centre for Health Policy (Katz, Fransoo, Prior), and Max Rady College of Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
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Skowronski J, Cho I, Mintz GS, Wolny R, Opolski MP, Cha MJ, Lee WS, Michalowska I, Kepka C, Kruk M, Tyczynski P, Kalinczuk L, Kukula K, Ciszewski M, Banasiak A, Chmielak Z, Witkowski A, Kim SW, Pregowski J. Inter-ethnic differences in normal coronary anatomy between Caucasian (Polish) and Asian (Korean) populations. Eur J Radiol 2020; 130:109185. [PMID: 32771813 DOI: 10.1016/j.ejrad.2020.109185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/14/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Little is known about ethnic differences in the size of coronary arteries in disease-free individuals. Our aim was to compare coronary artery dimensions between Asian and Caucasian population without atherosclerosis. METHODS One hundred and twelve Caucasian patients without any discernible atherosclerosis detected on coronary computed tomography angiography were matched with 112 Asian patients using sex, age, coronary dominance pattern and body surface area (BSA). Maximal and minimal lumen areas (LA) and diameters (LD) of proximal and middle coronary segments were measured, and the mean values were used for analyses. RESULTS Caucasians had larger LA and LD than Asian patients in all proximal coronary segments. Overall, the mean difference in LA and LD was 11.4 % and 5.2 %, respectively. Significant differences were observed for all proximal segments (left anterior descending: 13 % and 6%, left circumflex 14 % and 8% and right coronary artery 8% and 4% for LA and LD), but not for mid segments. The greatest difference between Caucasians and Asians was found in left main coronary artery (LMCA) LA (21.2 ± 6.5 vs.16.8 ± 5.4 mm2, p < 0.01 respectively). The independent predictors of larger LA and LD of LMCA and proximal coronary segments were male sex (p < 0.05), Caucasian ethnicity (p < 0.05), and left dominance pattern (p < 0.05). CONCLUSION In subjects without atherosclerosis, Asians have smaller dimensions of all proximal coronary arteries, most prominently displayed in LMCA, than the Caucasians regardless of age, sex, or body size.
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Affiliation(s)
- Jaroslaw Skowronski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Iksung Cho
- Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Gary S Mintz
- Cardiovascular Research Foundation, Broadway 1700, 10019, New York, NY, United States.
| | - Rafal Wolny
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Min Jae Cha
- Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Wang Soo Lee
- Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Ilona Michalowska
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Cezary Kepka
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Mariusz Kruk
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Pawel Tyczynski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Lukasz Kalinczuk
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Krzysztof Kukula
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Michal Ciszewski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Adam Banasiak
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Zbigniew Chmielak
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Sang-Wook Kim
- Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Jerzy Pregowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
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