The Impact of Ethnicity on STEMI Patients in Jerusalem
Background: It has previously been demonstrated that coronary risk factors are particularly high among Arabs.
Aim: To explore whether Arab ethnicity had an impact on patients (pts) with STEMI who underwent primary percutaneous coronary interventions (PPCI) in regard to time required to hospital arrival, prescription of guidelines recommended medications (GRM) at discharge and outcome.
Methods: Between 1/2005-10/2018 all pts with STEMI who underwent PPCI and had documented time intervals were included in the study. Retrospective analyses of prospectively collected computerized pts` data were used to compare between Arabs and Jews. Mortality data was retrieved from the National Registry.
Results: 1830 STEMI pts were included, of whom 400(22%) were Arabs. Median [IQR] follow up time was 679 [83-1808] days.
Table:
|
Arabs n=400 |
Jews n=1430 |
p-Value | |
|
Age yrs (mean+SD) |
58+12 |
62+12 |
<0.0001 |
|
Hypertension(%) |
43 |
43 |
NS |
|
Diabetes(%) |
34 |
24 |
<0.0001 |
|
Hyperlipidemia(%) |
50 |
49 |
NS |
|
Current smokers(%) |
71 |
54 |
<0.0001 |
|
Prior PCI(%) |
18 |
14 |
0.04 |
|
Pain onset to hospital arrival, minutes, Median[IQR] |
113 (66-195) |
104 (61-200) |
NS |
|
Door to needle |
48 (20-76) |
40 (16-74) |
0.06 |
|
CCU/CAT-LAB first ward(%) |
36 |
41 |
NS |
|
>2 vessel coronary disease(%) |
55 |
48 |
0.03 |
|
Discharge GRM≥4*(%) |
89 |
88 |
NS |
|
Mortality(n,%) |
37 (9.3) |
164 (11.5) |
NS |
* GRM: DAPT, ACEI/ARB, statins, beta-blockers.
A cox regression analysis including demographic, clinical characteristics and GRM>4 revealed that Arab ethnicity was not associated with increased mortality rate (HR=1.11 95% CI[0.72-1.71] p=0.621)
Conclusions: As compared to Jews STEMI pts, Arabs arrival to hospital was not delayed. However, Arabs were younger, more frequently diabetics, current smokers and had multivessel coronary disease. Both groups were similarly treated, mortality rates were similar and Arab ethnicity was not a predictor for increased mortality.
The younger age of STEMI Arab pts, their higher prevalence of diabetes and smoking emphasis the need to provide primary and secondary prevention modalities to this population.
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