Coronary plaque and clinical characteristics of South Asian (Indian) patients with acute coronary syndromes: An optical coherence tomography study
Graphic abstract
Introduction
Acute coronary syndrome (ACS) is one of the most frequent causes of hospitalization, morbidity, and mortality worldwide [1]. South Asians are known to have a higher incidence of premature atherosclerosis including ACS with worse outcomes, as compared to populations of other ethnic backgrounds. [[2], [3], [4]]. India has the largest population among South Asian countries and it is estimated that large numbers of patients are suffering from coronary artery disease (CAD) [5]. The number of patients with atherosclerotic disease is dramatically increasing in South Asia and this region is expected to have more patients with atherosclerotic disease than any other parts of the world in the near future [2,6]. In addition, ACS occurs at a younger age and is associated with higher mortality in the South Asian population [4,6,7]. The high rate of ACS is often explained by the higher prevalence of conventional atherosclerotic risk factors, such as diabetes mellitus (DM) or dyslipidemia, at a younger age [8,9]. Genetic factors have also been reported to affect the prevalence of ACS in the South Asian population [6]. However, despite these observations, data on coronary plaque characteristics in South Asian patients are limited.
Recently, the concept of “vulnerable plaque” is gaining attention. Vulnerable plaque is a plaque at higher risk for future disruption leading to occlusive thrombosis [10]. Thin-cap fibroatheroma (TCFA), macrophages, cholesterol crystal, and microvessels identified by optical coherence tomography (OCT) are considered features of plaque vulnerability [11,12].
This study was conducted to evaluate culprit plaque characteristics in Indian patients with ACS as compared to those in other ethnic populations (East Asian and White) using OCT.
Section snippets
Study population
The study population was from the “Identification of Predictors for Coronary Plaque Erosion in Patients with Acute Coronary Syndrome” study (NCT03479723). This was a multicenter cross-sectional international collaborative study, and approval was obtained from the institutional review board at each participating site [13]. Patients with ACS who had OCT imaging of their culprit lesions were enrolled. The diagnosis of ACS included ST-segment elevation myocardial infarction (STEMI) and
Baseline characteristics
Baseline characteristics are shown in Table 1. Among 1315 patients, 100 patients were South Asian (Chennai and Kochi, South India), 1009 were East Asian, and 206 were White. The distributions of patients with different ethnic backgrounds per age group are shown in Fig. 1. Compared to East Asians and Whites, South Asians were significantly younger. STEMI was the predominant type of presentation in the South Asian group (77.0%), whereas NSTE-ACS was the more frequent in the White group (64.6%).
Discussion
To the best of our knowledge, this is the first report on culprit plaque characteristics in South Asian (Indian) patients with ACS using OCT imaging. Our study demonstrated that South Asian patients with ACS, as compared to those with East Asian and White ethnic backgrounds, (1) were younger with a significantly higher rate of STEMI; (2) had plaque erosion as the predominant underlying mechanism of ACS; and (3) had greater plaque burden (greater prevalence of 3 vessel disease and longer lesion
Conclusions
This study demonstrated that South Asian (Indian) patients present with ACS at a younger age and with a higher rate of STEMI as compared to populations with different ethnic backgrounds. In addition, plaque erosion was the predominant underlying pathology for ACS in South Asian patients. Moreover, South Asian patients had greater features of plaque vulnerability in the culprit lesion, compared to the other ethnic groups.
Source of funding
Dr. Jang's research was supported by Mr. and Mrs. Allan and Gill Gray, and Mr. and Mrs. Michael and Kathryn Park. They had no role in the design or conduct of this research.
Disclosures
Dr. Jang has received educational grant support from Abbott Vascular and a consulting fee from Svelte Medical Systems and Mitobridge Inc. All other authors have no relationships relevant to the contents of this paper to disclose.
Author statement
Ik-Kyung Jang had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Acknowledgments
None.
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