Key result
South Asian ethnicity is linked to ~67% higher odds of obstructive CAD vs. White patients.
Why the study?
Appropriate selection of patients with stable CAD for coronary angiography depends on pretest probability, but potential differences in CAD by race and ethnic groups remain poorly understood.
Does South Asian or East Asian race/ethnicity influence the likelihood of detecting obstructive CAD in stable patients undergoing diagnostic coronary angiography?
Cohort (n=71,199)
Yes
Does South Asian or East Asian race/ethnicity influence the likelihood of detecting obstructive CAD in stable patients undergoing diagnostic coronary angiography?
Race and ethnicity are significant independent predictors of obstructive CAD, suggesting they should be incorporated into pretest probability and clinical risk prediction models.
May inform ethnicity-adjusted pretest probabilities; hypothesis-generating and requires prospective validation before practice change.
Background: Appropriate selection of patients with stable coronary artery disease (CAD) for coronary angiography is dependent on the pretest probability of obstructive CAD; however, little is known about the potential differences in CAD by race and ethnic groups. Objectives: The purpose of this study was to evaluate the association of race and ethnicity with coronary obstruction in stable CAD. Methods: We evaluated first coronary angiography for CAD evaluation between 2012 and 2019 in Ontario, Canada. Race and ethnicity were identified by physicians. The main outcome was the rate of obstructive CAD (left main stenosis ≥50% or major epicardial vessel stenosis ≥70%). Multivariable logistic regression analyses evaluated the independent association of race and ethnicity with CAD. Results: Among 71,199 CAD patients, 14.0% were South Asian (SA), 4.4% were East Asian (EA), and 58,131 were White patients. SA patients were the youngest at 60.9 years vs 62.4 years for EA patients and 65.1 years for White patients but were most likely to have obstructive CAD (46.9%) (EA 43.0% and White patients 37.9%). SA patients had the highest prevalence of 3-vessel CAD at 13.4% (vs 12.5% in EA and 7.7% in White patients). The adjusted odds ratio was 67% higher (1.67; 95% CI: 1.59 to 1.75) for having obstructive CAD in SA patients than that in White patients. EA patients also had significantly increased adjusted odds of obstructive CAD compared with White patients (1.40; 95% CI: 1.29-1.52). Conclusions: SA patients were younger at presentation but had the highest adjusted odds of obstructive CAD. Incorporation of race and ethnicity information may improve risk-prediction tools for detection of coronary obstruction.
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Rooprai et al. (2023) conducted a cohort in Stable coronary artery disease (CAD) (n=71,199). South Asian race and ethnicity vs. White race and ethnicity was evaluated on Rate of obstructive CAD (left main stenosis ≥50% or major epicardial vessel stenosis ≥70%) (aOR 1.67, 95% CI 1.59-1.75, p=<0.0001). South Asian race and ethnicity was associated with a 67% higher adjusted odds of obstructive coronary artery disease compared with White patients during initial evaluation.
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