Ethnic disparities and surgical outcome equity in CABG for acute myocardial infarction: a single-centre retrospective cohort
H N Al Houri, M T A Egaimi, J ChangAbstract
Background
Ethnic heterogeneity influences cardiometabolic risk in coronary artery disease, but whether it translates into different early outcomes after urgent CABG for acute myocardial infarction (AMI) in universal-access systems is unclear.
Methods
We retrospectively analysed 143 consecutive patients undergoing CABG for AMI (2015–2022) at a tertiary centre: South-Asian (n=86), Middle-Eastern (n=44), African (n=10), and Other-Asian (n=3). Primary outcomes were in-hospital mortality and postoperative length of stay (PLOS; operative-to-discharge days). Categorical variables were compared using chi-square tests. Given the non-normality of PLOS (Shapiro–Wilk p<0.001 in most strata), PLOS was compared using Welch ANOVA.
Results
South-Asian patients presented younger than pooled non–South-Asian patients (52.8±8.0 vs 59.7±10.7 years; Δ −6.9 years, 95% CI −10.1 to −3.6; p<0.001) and demonstrated higher metabolic burden (HbA1c 7.68±2.2%; LDL 124.5±51.2 mg/dL; LDL p=0.03). Marked sex imbalance was observed across groups (p<0.001). Surgical approach was predominantly on-pump (136/143; 95.1%) without ethnic variation (p=0.794), and AMI phenotype (NSTEMI vs STEMI) was similar across ethnicities (p=0.604). In-hospital mortality was low (4/143; 2.8%) with no observed difference by ethnicity (0/10 African, 2/44 Middle-Eastern, 2/86 South-Asian, 0/3 Other-Asian; χ²=0.939, p=0.816). Mean PLOS was 14.5±5.9 (African), 16.6±19.9 (Middle-Eastern), 13.9±7.3 (South-Asian), and 17.3±5.5 days (Other-Asian), with no difference on Welch ANOVA (F=0.511, p=0.685).
Conclusion
Despite ethnic variation in age at presentation and cardiometabolic profile, early postoperative outcomes after CABG for AMI were similar in this single-centre cohort under a universal-access system. However, very small minority strata and low event rates limit power and preclude robust adjusted analyses; findings should be considered exploratory and warrant confirmation in larger multicentre studies.For image description, please refer to the figure legend and surrounding text.Visual AbstractFor image description, please refer to the figure legend and surrounding text.