Hypothesis of Long-Term Outcome after Coronary Revascularization in Japanese Patients Compared to Multiethnic Groups in the US

<div><p>Background</p><p>Ethnicity has a significant impact on coronary artery disease (CAD). This study investigated the long-term outcomes of Japanese patients undergoing revascularization compared with US patients belonging to multiple ethnic groups.</p><p>Methods and Results</p><p>We evaluated clinical outcomes, based on ethnicity, of patients included in the Coronary Revascularization Demonstrating Outcome (CREDO-Kyoto) and the Texas (US) Heart Institute Research Database (THIRDBase) registries. For the analysis, we included 8871 patients from the CREDO-Kyoto registry (median follow-up period [FU], 3.5 years; interquartile range [IQR], 2.6–4.3) and 6717 patients from the THIRDBase registry (FU, 5.2 years; IQR, 3.8–6.5) who underwent percutaneous coronary intervention or bypass surgery. Cox proportional hazard models were constructed to compare the adjusted long-term outcomes for each ethnic group. A total of 8871 Japanese, 5170 Caucasians, 648 African-Americans, 817 Hispanics, and 82 Asian-Americans were identified. When adjusted, Japanese patients had significantly better outcomes than US patients, classified by ethnicity (Caucasians: hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.35–1.79; Hispanics: HR, 1.53; 95% CI, 1.22–1.93; African-Americans: HR, 2.03; 95% CI, 1.62–2.56), except for Asian-Americans (HR, 0.84; 95% CI. 0.38–1.89) who had outcomes similar to Japanese patients.</p><p>Conclusion</p><p>Our findings indicate better survival outcomes in re-vascularized Japanese CAD patients compared to major ethnic groups in the US, including Caucasian, Hispanic, and African-American CAD patients. The characteristics and outcomes of Japanese CAD patients were similar to those of Asian-Americans, despite the sample size limitations in the US dataset.</p></div

Results of Cox regression analysis.

<p>Abbreviation: HR, hazard ratio; CI, confidence interval; NYHA, New York Heart Association; CAD, coronary artery disease.</p><p>Multivariate-Adjusted for age ≥65, gender, obesity, history of MI, diabetes, heart failure, NYHA functional class, peripheral vascular disease, renal function, hypertension, hyperlipidemia, family history of CAD, smoking, the number of diseased vessels, and ethnicities. All analyses were stratified by the revascularization procedure.</p><p>Results of Cox regression analysis.</p

Kaplan-Meyer survival curves, based on patient ethnicity.

<p>Kaplan-Meyer survival curves, based on patient ethnicity.</p

Baseline characteristics of each ethnic population.

<p>Abbreviations: BMI, body mass index; MI, myocardial infarction; HF, heart failure; NYHA, New York Heart Association; CAD, coronary artery disease.</p><p>Baseline characteristics of each ethnic population.</p

Myasthenia Gravis Foundation of America (MGFA) clinical classification by myasthenia gravis categories.

Bar graph plot of Myasthenia Gravis Foundation of America (MGFA) clinical classification of myasthenia gravis (MG) categories. The clinical classification was done according to maximum disease severity. The X-axis indicates categories of MG. Y-axis indicates the patients’ number.</p

Minimal data for the second survey.

(XLSX)</p

Therapies and outcome by categories.

Therapies and outcome by categories.</p

Study Cohort Creation.

<p>Study Cohort Creation.</p

Masaoka staging of thymoma.

(DOCX)</p

Patient records for the second survey.

(DOCX)</p