Ethnic Differences in Thrombotic Profiles of Acute Coronary Syndrome Patients and Relationship to Cardiovascular Outcomes: A Comparison of East Asian and White subjects

Author:

Suh Jung-Won1,Memtsas Vassilios2,Gue Ying X3,Cho Hyoung-Won1,Lee Wonjae1,Kang Si-Hyuck1,Gorog Diana A.24ORCID

Affiliation:

1. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

2. Cardiovascular Division, Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom

3. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom

4. Centre for Health Services and Clinical Research, Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom

Abstract

Background East Asians (EAs), compared to white Caucasians (W), have a lower risk of ischemic heart disease and a higher risk of bleeding with antithrombotic medications. The underlying mechanisms are incompletely understood. Objectives We sought to compare thrombotic profiles of EA and W patients with myocardial infarction (MI) and relate these to cardiovascular outcomes. Methods In a prospective study in the United Kingdom and Korea, blood samples from patients (n = 515) with ST- or non-ST-elevation MI (STEMI and NSTEMI) were assessed using the Global Thrombosis Test, measuring thrombotic occlusion (OT) and endogenous fibrinolysis (lysis time [LT]). Patients were followed for 1 year for major adverse cardiovascular events (MACE) and bleeding. Results EA patients showed reduced OT (longer OT) compared to W (646 seconds [470–818] vs. 436 seconds [320–580], p < 0.001), with similar LT. In STEMI, OT (588 seconds [440–759] vs. 361 seconds [274–462], p < 0.001) and LT (1,854 seconds [1,389–2,729] vs. 1,338 seconds [1,104–1,788], p < 0.001) were longer in EA than W. In NSTEMI, OT was longer (OT: 734 seconds [541–866] vs. 580 seconds [474–712], p < 0.001) and LT shorter (1519 seconds [1,058–2,508] vs. 1,898 seconds [1,614–2,806], p = 0.004) in EA than W patients. MACE was more frequent in W than EA (6.3 vs. 1.9%, p = 0.014) and bleeding infrequent. While OT was unrelated, LT was a strong independent predictor of MACE event after adjustment for risk factors (hazard ratio: 3.70, 95% confidence interval: 1.43–9.57, p = 0.007), predominantly in W patients, and more so in STEMI than NSTEMI patients. Conclusion EA patients exhibit different global thrombotic profiles to W, associated with a lower rate of cardiovascular events.

Funder

Korean Society of Interventional Cardiology

Publisher

Georg Thieme Verlag KG

Subject

Hematology

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