Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients
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{"title"=>"Inter-ethnic differences in quantified coronary artery disease severity and all- cause mortality among Dutch and singaporean percutaneous coronary intervention patients", "type"=>"journal", "authors"=>[{"first_name"=>"Crystel M.", "last_name"=>"Gijsberts", "scopus_author_id"=>"55879300600"}, {"first_name"=>"Aruni", "last_name"=>"Seneviratna", "scopus_author_id"=>"55227389800"}, {"first_name"=>"Imo E.", "last_name"=>"Hoefer", "scopus_author_id"=>"6602179811"}, {"first_name"=>"Pierfrancesco", "last_name"=>"Agostoni", "scopus_author_id"=>"11839221100"}, {"first_name"=>"Saskia Z.H.", "last_name"=>"Rittersma", "scopus_author_id"=>"8253497700"}, {"first_name"=>"Gerard", "last_name"=>"Pasterkamp", "scopus_author_id"=>"7004573949"}, {"first_name"=>"Mikael", "last_name"=>"Hartman", "scopus_author_id"=>"22234057900"}, {"first_name"=>"Leonardo Pinto", "last_name"=>"De Carvalho", "scopus_author_id"=>"23088340100"}, {"first_name"=>"A. Mark", "last_name"=>"Richards", "scopus_author_id"=>"7402299599"}, {"first_name"=>"Folkert W.", "last_name"=>"Asselbergs", "scopus_author_id"=>"7006736234"}, {"first_name"=>"Dominique P.V.", "last_name"=>"De Kleijn", "scopus_author_id"=>"7003654548"}, {"first_name"=>"Mark Y.", "last_name"=>"Chan", "scopus_author_id"=>"23388249600"}], "year"=>2015, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84940416718", "doi"=>"10.1371/journal.pone.0131977", "pui"=>"605749935", "sgr"=>"84940416718"}, "id"=>"8e51c141-44d5-3dd0-ac4f-0ad7456d3ba6", "abstract"=>"? 2015 Gijsberts et al.Background Coronary artery disease (CAD) is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic \"synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery\" (SYNTAX) score quantifies CAD severity and predicts outcomes. We studied CAD severity and all-cause mortality in four globally populous ethnic groups: Caucasians, Chinese, Indians and Malays. Methods We quantified SYNTAX scores of 1,000 multi-ethnic patients undergoing PCI in two tertiary hospitals in the Netherlands (Caucasians) and Singapore (Chinese, Indians and Malays). Within each ethnicity we studied 150 patients with stable CAD and 100 with ST-elevated myocardial infarction (STEMI). We made inter-ethnic comparisons of SYNTAX scores and all-cause mortality. Results Despite having a younger age (mean age Indians: 56.8 and Malays: 57.7 vs. Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1- 10.8], p<0.001. Among STEMI patients, SYNTAX scores were highest in Chinese and Malays: 17.7 [15.9-19.5] and 18.8 [17.1-20.6] vs. 15.5 [13.5-17.4] and 12.7 [10.9-14.6] in Indians and Caucasians, p<0.001. Over a median follow-up of 709 days, 67 deaths (stable CAD: 37, STEMI: 30) occurred. Among STEMI patients, the SYNTAX score independently predicted all-cause mortality: HR 2.5 [1.7-3.8], p<0.001 for every 10-point increase. All-cause mortality was higher in Indian and Malay STEMI patients than Caucasians, independent of SYNTAX score (adjusted HR 7.2 [1.5-34.7], p=0.01 and 5.8 [1.2-27.2], p=0.02). Conclusion Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age. Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause mortality than Caucasians, independent of SYNTAX score. Copyright:", "link"=>"http://www.mendeley.com/research/interethnic-differences-quantified-coronary-artery-disease-severity-cause-mortality-among-dutch-sing", "reader_count"=>8, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Researcher"=>1, "Student > Ph. D. Student"=>1, "Other"=>3, "Student > Master"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Researcher"=>1, "Student > Ph. D. Student"=>1, "Other"=>3, "Student > Master"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Biochemistry, Genetics and Molecular Biology"=>1, "Medicine and Dentistry"=>4}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>4}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Unspecified"=>{"Unspecified"=>3}}, "group_count"=>0}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/2163608"], "description"=>"<p>Panel A: SYNTAX scores of stable CAD patients (n = 150 per ethnic group). Panel B: SYNTAX scores of STEMI patients (n = 100 per ethnic group). Point estimates and error bars show the mean SYNTAX scores with 95% confidence intervals. Different transparencies present: crude mean SYNTAX scores (highly transparent), mean SYNTAX scores adjusted for age (lightly transparent) and multivariable adjusted mean SYNTAX scores (solid). P-values displayed in the figure are derived from multivariable (full model) ANCOVA, followed by Tukey post-hoc testing. The full model contains: age, body mass index, diabetes, dyslipidemia, smoking, previous PCI, previous acute coronary syndrome, peripheral arterial disease, platelet inhibitor, statin and beta-blocker use.</p>", "links"=>[], "tags"=>["Quantified Coronary Artery Disease Severity", "SYNTAX scores", "mortality", "hr", "pci", "score quantifies CAD severity", "malays", "indian", "SYNTAX score", "Malay STEMI patients", "caucasian", "STEMI patients", "Singaporean Percutaneous Coronary Intervention Patients BackgroundCoronary artery disease"], "article_id"=>1474514, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Crystel M. Gijsberts", "Aruni Seneviratna", "Imo E. Hoefer", "Pierfrancesco Agostoni", "Saskia Z. H. Rittersma", "Gerard Pasterkamp", "Mikael Hartman", "Leonardo Pinto de Carvalho", "A. Mark Richards", "Folkert W. Asselbergs", "Dominique P. V. De Kleijn", "Mark Y. Chan"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0131977.g001", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_SYNTAX_scores_of_stable_CAD_and_STEMI_patients_stratified_by_ethnicity_/1474514", "title"=>"SYNTAX scores of stable CAD and STEMI patients, stratified by ethnicity.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-07-06 03:48:49"}
  • {"files"=>["https://ndownloader.figshare.com/files/2163610"], "description"=>"<p>Cox regression survival curves for up to 900 days of follow-up stratified by ethnicity. The survival curves are adjusted for age, sex, SYNTAX score and diabetes. The left panel displays the stable CAD patients, the right panel the STEMI patients. No significant ethnic differences were found among stable CAD patients. Among the STEMI patients, mortality was significantly higher in Malays (HR 5.8) and Indians (HR 7.2) as compared to Caucasians.</p>", "links"=>[], "tags"=>["Quantified Coronary Artery Disease Severity", "SYNTAX scores", "mortality", "hr", "pci", "score quantifies CAD severity", "malays", "indian", "SYNTAX score", "Malay STEMI patients", "caucasian", "STEMI patients", "Singaporean Percutaneous Coronary Intervention Patients BackgroundCoronary artery disease"], "article_id"=>1474516, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Crystel M. Gijsberts", "Aruni Seneviratna", "Imo E. Hoefer", "Pierfrancesco Agostoni", "Saskia Z. H. Rittersma", "Gerard Pasterkamp", "Mikael Hartman", "Leonardo Pinto de Carvalho", "A. Mark Richards", "Folkert W. Asselbergs", "Dominique P. V. De Kleijn", "Mark Y. Chan"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0131977.g002", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cox_regression_survival_curves_for_up_to_900_days_of_follow_up_stratified_by_ethnicity_/1474516", "title"=>"Cox regression survival curves for up to 900 days of follow-up stratified by ethnicity.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-07-06 03:48:49"}
  • {"files"=>["https://ndownloader.figshare.com/files/2163611"], "description"=>"<p>Figures represent percentages or means ± standard deviation. SYNTAX scores are presented as means with confidence intervals. Fully adjusted SYNTAX scores are adjusted for age, BMI, diabetes, dyslipidemia, smoking, previous PCI, previous ACS, peripheral arterial disease, use of platelet inhibitor, use of statin and use of beta blocker.</p><p>* p-value for difference across all smoking groups, across all ethnic groups. n/a: chi-square test results are not robust due to <5 observations in a group. SD = standard deviation, CI = confidence interval. Significance of differences was tested with ANOVA for continuous measures, ANCOVA for adjusted SYNTAX scores and chi-square testing for proportional measures.</p><p>Baseline characteristics and SYNTAX scores of stable CAD and STEMI patients.</p>", "links"=>[], "tags"=>["Quantified Coronary Artery Disease Severity", "SYNTAX scores", "mortality", "hr", "pci", "score quantifies CAD severity", "malays", "indian", "SYNTAX score", "Malay STEMI patients", "caucasian", "STEMI patients", "Singaporean Percutaneous Coronary Intervention Patients BackgroundCoronary artery disease"], "article_id"=>1474517, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Crystel M. Gijsberts", "Aruni Seneviratna", "Imo E. Hoefer", "Pierfrancesco Agostoni", "Saskia Z. H. Rittersma", "Gerard Pasterkamp", "Mikael Hartman", "Leonardo Pinto de Carvalho", "A. Mark Richards", "Folkert W. Asselbergs", "Dominique P. V. De Kleijn", "Mark Y. Chan"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0131977.t001", "stats"=>{"downloads"=>3, "page_views"=>21, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Baseline_characteristics_and_SYNTAX_scores_of_stable_CAD_and_STEMI_patients_/1474517", "title"=>"Baseline characteristics and SYNTAX scores of stable CAD and STEMI patients.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-07-06 03:48:49"}
  • {"files"=>["https://ndownloader.figshare.com/files/2163612"], "description"=>"<div><p>Background</p><p>Coronary artery disease (CAD) is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic “synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery” (SYNTAX) score quantifies CAD severity and predicts outcomes. We studied CAD severity and all-cause mortality in four globally populous ethnic groups: Caucasians, Chinese, Indians and Malays.</p><p>Methods</p><p>We quantified SYNTAX scores of 1,000 multi-ethnic patients undergoing PCI in two tertiary hospitals in the Netherlands (Caucasians) and Singapore (Chinese, Indians and Malays). Within each ethnicity we studied 150 patients with stable CAD and 100 with ST-elevated myocardial infarction (STEMI). We made inter-ethnic comparisons of SYNTAX scores and all-cause mortality.</p><p>Results</p><p>Despite having a younger age (mean age Indians: 56.8 and Malays: 57.7 vs. Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001. Among STEMI patients, SYNTAX scores were highest in Chinese and Malays: 17.7 [15.9-19.5] and 18.8 [17.1-20.6] vs. 15.5 [13.5-17.4] and 12.7 [10.9-14.6] in Indians and Caucasians, p<0.001.</p><p>Over a median follow-up of 709 days, 67 deaths (stable CAD: 37, STEMI: 30) occurred. Among STEMI patients, the SYNTAX score independently predicted all-cause mortality: HR 2.5 [1.7-3.8], p<0.001 for every 10-point increase. All-cause mortality was higher in Indian and Malay STEMI patients than Caucasians, independent of SYNTAX score (adjusted HR 7.2 [1.5-34.7], p=0.01 and 5.8 [1.2-27.2], p=0.02).</p><p>Conclusion</p><p>Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age. Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause mortality than Caucasians, independent of SYNTAX score.</p></div>", "links"=>[], "tags"=>["Quantified Coronary Artery Disease Severity", "SYNTAX scores", "mortality", "hr", "pci", "score quantifies CAD severity", "malays", "indian", "SYNTAX score", "Malay STEMI patients", "caucasian", "STEMI patients", "Singaporean Percutaneous Coronary Intervention Patients BackgroundCoronary artery disease"], "article_id"=>1474518, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Crystel M. Gijsberts", "Aruni Seneviratna", "Imo E. Hoefer", "Pierfrancesco Agostoni", "Saskia Z. H. Rittersma", "Gerard Pasterkamp", "Mikael Hartman", "Leonardo Pinto de Carvalho", "A. Mark Richards", "Folkert W. Asselbergs", "Dominique P. V. De Kleijn", "Mark Y. Chan"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0131977", "stats"=>{"downloads"=>1, "page_views"=>17, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Inter_Ethnic_Differences_in_Quantified_Coronary_Artery_Disease_Severity_and_All_Cause_Mortality_among_Dutch_and_Singaporean_Percutaneous_Coronary_Intervention_Patients_/1474518", "title"=>"Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-07-06 03:48:49"}

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Relative Metric

{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}
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