Key result
Māori and Pacific patients <55 years had the lowest CTCA-to-ACS ratios and most extensive CAD, but received equal post-CTCA statin therapy.
Why the study?
Ethnic differences in computed tomography coronary angiography utilisation, extent of coronary artery disease, and statin use among patients with chest pain at Middlemore Hospital in New Zealand warranted assessment.
Cohort (n=4,519)
No
Although young Māori and Pacific patients with chest pain are underinvestigated with CTCA relative to their population CAD burden and have more extensive atherosclerosis, identifying CAD via CTCA leads to equitable statin prescribing across all ethnic groups.
Answers are grounded in this paper and cite their sources.
Māori and Pacific patients warrant heightened CAD risk vigilance on CTCA; leaves open whether ethnicity-specific thresholds improve outcomes or statin use.
Background We assessed ethnic differences in computed tomography coronary angiography (CTCA) utilisation, extent of coronary artery disease (CAD), and statin use among patients with chest pain at Middlemore Hospital, New Zealand. Method Patients without prior revascularisation (n=4,519) who underwent CTCA (2020–2024) were identified from the Aotearoa New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) cardiac computed tomography registry. CTCA utilisation was assessed relative to incident acute coronary syndrome (ACS) hospitalisations in each age and ethnic group, which served as a surrogate for population CAD burden. CAD extent was assessed using the segment involvement score. Statin dispensing data were obtained from the national pharmaceutical data set. Results The cohort comprised 37.8% European/Other, 13.4% Māori, 19.8% Pacific, 15.5% Indian, and 13.5% other Asian patients. Māori, Pacific, and Indian patients (mean age, 55.7, 54.8, and 54.0 years, respectively) were younger than other Asian and European/Other patients (59.2 and 60.4 years, respectively; p<0.001). CTCA utilisation among those aged <55 years was lowest among Māori and Pacific patients, intermediate among European/Other and Indian patients, and highest among other Asian patients (CTCA-to-incident-ACS ratios, 2.5, 2.2, 3.0, 3.8, and 8.0, respectively). Indian and other Asian patients were most likely to have normal coronary arteries (p<0.001), while Māori and Pacific patients had the most extensive atherosclerosis (p<0.001). Post-CTCA statin use, for equivalent disease severity, was similar across ethnicities. Conclusions Young Māori and Pacific patients with chest pain are underinvestigated and undertreated relative to their population CAD burden. However, when CAD is identified, statin treatment is equal across ethnic groups. Therefore, CTCA facilitates equitable treatment for Māori and Pacific patients presenting with chest pain.
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Lee et al. (2026) conducted a cohort in Chest pain / Coronary artery disease (n=4,519). Ethnic variation in CTCA utilisation vs. Different ethnic groups (European/Other, Māori, Pacific, Indian, other Asian) was evaluated on CTCA utilisation relative to incident ACS, CAD extent, and post-CTCA statin use (p=<0.001). Māori and Pacific patients <55 years had the lowest CTCA-to-ACS ratios and most extensive CAD, but received equal post-CTCA statin therapy.
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