Comparison of baseline characteristics, treatment patterns, and in-hospital outcomes of Asian versus non-Asian white Americans with non-ST-segment elevation acute coronary syndromes from the CRUSADE quality improvement initiative

Abstract

It has been suggested that Asians may respond differently to antithrombotic therapy, but contemporary management and outcomes of non-ST-segment elevation (NSTE) acute coronary syndromes (ACSs) in Asian patients have not been well characterized. Using data from the CRUSADE initiative, we compared baseline characteristics, treatment patterns, and in-hospital outcomes between 1,071 Asian and 72,513 non-Asian white patients hospitalized with NSTE ACS. Asian patients were more likely to have hypertension, diabetes, and renal insufficiency compared with non-Asian whites. Body mass index was lower in Asian patients (24.9 vs 27.8 kg/m(2), p <0.0001). Use of acute medical therapies, cardiac catheterization, and percutaneous or surgical revascularization did not significantly differ between Asian and white groups after adjustment for patient and hospital characteristics. In-hospital mortality (5.0% vs 4.4%, adjusted odds ratio [OR] 1.24, 95% confidence interval [CI] 0.88 to 1.73) and reinfarction rates (2.0% vs 2.3%. adjusted OR 0.94, 95% CI 0.65 to 1.38) were also similar. In contrast, rates of major bleeding (13.4% vs 9.4%, p <0.0001) and red blood cell transfusion (9.6% vs 6.6%, p = 0.0005) were significantly higher in the Asian population and this higher bleeding risk persisted after adjustment for bleeding risk factors and body mass index; adjusted ORs were 1.32 (95% CI 1.08 to 1.62) and 1.32 (95% CI 1.01 to 1.72), respectively. In conclusion, despite similar treatment, Asian patients with NSTE ACS have significantly higher bleeding risk even after adjustment for risk factors and body mass index. Further investigation is needed to explore the potential for ethnic variability in antithrombotic susceptibility.