Key result
Asian ACS patients present with classical symptom locations ~10% more frequently than Caucasian patients.
Why the study?
Demographics and symptom presentation differences between Asian and Caucasian patients with acute coronary syndromes were not well described.
Do Asian and Caucasian patients with acute coronary syndromes present with different demographics and symptoms?
Observational
No
Do Asian and Caucasian patients with acute coronary syndromes present with different demographics and symptoms?
Absolute Event Rate: 90% vs 82%
p-value: p=<0.001
Asian patients with acute coronary syndromes present at a younger age with more diabetes and different symptom distributions compared to Caucasian patients, highlighting the need for racially aware diagnostic approaches.
Ethnic differences in ACS symptoms warrant clinician awareness; observational data leaves open effects on diagnosis or outcomes.
OBJECTIVE: To describe and compare demographics and symptom presentation in Asian and Caucasian patients with acute coronary syndromes. DESIGN: Long-term prospective survey of symptom presentations in two racial groups. SETTING: A London hospital. PARTICIPANTS: A consecutive series of patients admitted to hospital with acute coronary syndromes between November 2001 and November 2005. MAIN OUTCOME MEASURE: Comparison of demographics and location, character, intensity and symptom distribution at presentation between Asian and Caucasian patients. RESULTS: Asian patients were younger than Caucasian patients (61 v 69 years, p<0.001) and more had diabetes (43% v 17%, p<0.001). Proportionally, more Asian patients had angina (51% v 37%, p<0.001), but more Caucasian patients had myocardial infarction (63% v 49%, p<0.001) and non-ST elevation infarcts (40% v 29%, p<0.001). Men reported smaller areas of discomfort than women. Asian patients more frequently reported discomfort over the rear of their upper bodies compared to Caucasian patients (46% v 25%, p<0.001) and radiation of discomfort to their arms and necks. A higher percentage of Asian than Caucasian patients demonstrated a "classical" location of symptoms (90% v 82%, p<0.001). Patients with diabetes were more likely to feel no discomfort. A higher percentage of Caucasian than Asian patients presented with "silent" events (13% v 6%, p>0.001), with age being a major determinant. CONCLUSION: Asian patients were younger, more likely to be diabetic and tended to report a higher intensity of pain and over a greater area of their body, and more frequent discomfort over the rear of their upper thorax than Caucasian patients.
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Lalondrelle et al. (2006) conducted an observational in acute coronary syndromes. Asian ethnicity vs. Caucasian ethnicity was evaluated on classical location of symptoms (p=<0.001). Asian patients with acute coronary syndromes presented more frequently with a classical location of symptoms compared to Caucasian patients (90% vs 82%, p<0.001).
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