Goldsmith I, Lip G Y, Tsang G, Patel R L
Department of Cardiothoracic Surgery, Walsgrave Hospital, Coventry, U.K.
Eur Heart J. 1999 Aug;20(15):1094-100. doi: 10.1053/euhj.1998.1450.
To compare the clinical characteristics, at the time of admission and after coronary revascularization by bypass surgery, among British patients of Indo-Asian and white Caucasian descent.
One hundred and ninety-four pairs of patients admitted between November 1994 and January 1997 were matched for age (within 3 years), sex and date of admission (within 3 months). Their clinical characteristics at the time of admission for coronary artery bypass grafting surgery, and the incidence of hospital morbidity, hospital mortality and length of stay in the intensive therapy unit or hospital following coronary artery bypass grafting were determined.
A higher proportion of Indo-Asian patients underwent coronary revascularization on a non-elective basis (43% vs 32% white Caucasian patients, P =0.018), had a higher prevalence of diabetes (39% vs 12%, P =0.0001), a lower prevalence of smoking (36% vs 80%, P =0.0001) and a lower rate of previous myocardial infarction (47% vs 62%, P =0.012). As regards revascularization, although there was no significant difference in the number of vessels revascularized, there was a lower use of the arterial conduit (internal mammary artery) in the Indo-Asian patients (72% vs 81%, P =0.028) particularly for those undergoing emergency/urgent surgery (59% vs 72%, P =0.001) and with a previous myocardial infarction (65% vs 81%;P =0.01) when compared with their white Caucasian counterparts. Following surgery there were no differences in the types of support required for vital functions. There was no significant difference in the proportion of major post-operative complications, that is, haemorrhage, cerebrovascular accident, renal failure requiring dialysis or respiratory failure. Similarly, there were no differences in the length of intensive therapy unit stay (median stay 1 day vs 1 day, P =0.4) and hospital stay following surgery (median stay 6 days vs 6 days, P =0.5) between the two groups. Although there was a trend towards a higher in-hospital (30 day) mortality (6.7% [95% confidence intervals CI 3.18-10.21] vs 2.6% [CI 0.35-4.9;P =0.0618]), in Indo-Asians compared to white Caucasians this trend disappeared when patients in the two groups undergoing non-elective surgery only were compared (9% vs 7%;P =0.7).
A higher proportion of Indo-Asians underwent non-elective coronary revascularization, with a significantly lower use of the arterial conduit and a relatively higher in-hospital mortality. Following coronary revascularization the medical management, length of stay and hospital morbidity in Indo-Asian patients was no different from that of their white Caucasian counterparts. This is despite a perceived poorer outcome in Indo-Asians compared to white Caucasians.
比较印度裔亚洲人和白种英国患者在入院时以及冠状动脉搭桥手术血运重建后的临床特征。
对1994年11月至1997年1月期间入院的194对患者进行年龄（3岁以内）、性别和入院日期（3个月以内）匹配。确定他们在冠状动脉搭桥手术入院时的临床特征，以及冠状动脉搭桥手术后的医院发病率、医院死亡率和重症监护病房或医院的住院时间。
较高比例的印度裔亚洲患者接受了非选择性冠状动脉血运重建（43% 对比白种患者的32%，P = 0.018），糖尿病患病率较高（39% 对比12%，P = 0.0001），吸烟率较低（36% 对比80%，P = 0.0001），既往心肌梗死发生率较低（47% 对比62%，P = 0.012）。关于血运重建，虽然血运重建的血管数量没有显著差异，但印度裔亚洲患者较少使用动脉导管（乳内动脉）（72% 对比81%，P = 0.028），特别是与白种患者相比，在接受急诊/紧急手术的患者中（59% 对比72%，P = 0.001）以及有既往心肌梗死的患者中（65% 对比81%；P = 0.01）。手术后，维持生命功能所需的支持类型没有差异。主要术后并发症（即出血、脑血管意外、需要透析的肾衰竭或呼吸衰竭）的比例没有显著差异。同样，两组之间在重症监护病房的住院时间（中位住院时间1天对比1天，P = 0.4）和手术后的住院时间（中位住院时间6天对比6天，P = 0.5）也没有差异。虽然印度裔亚洲人院内（30天）死亡率有升高趋势（6.7% [95%置信区间CI 3.18 - 10.21] 对比2.6% [CI 0.35 - 4.9；P = 0.0618]），但当仅比较两组接受非选择性手术的患者时，这种趋势消失（9% 对比7%；P = 0.7）。
较高比例的印度裔亚洲人接受了非选择性冠状动脉血运重建，动脉导管使用显著减少，院内死亡率相对较高。冠状动脉血运重建后，印度裔亚洲患者的医疗管理、住院时间和医院发病率与白种患者没有差异。尽管人们认为印度裔亚洲人的预后比白种人差。
