Examining the Association Between Diabetes and Cardiovascular Outcomes in South Asian Compared with White North American Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction.

The aim of this study was to examine the frequency and impact of diabetes (DM) in South Asian (SA) compared with white North American (WNA) patients with ST-elevation myocardial infarction (STEMI). Consecutive patients undergoing primary percutaneous coronary intervention (PPCI) for STEMI between 2016 and 2018 were included for analysis. Patients with and without DM were divided into distinct cohorts. Cardiovascular outcomes at one-year, including mortality and composite major adverse cardiovascular events (MACE), were compared between SA and WNA in each cohort. Overall, 1303 patients underwent PPCI for STEMI. Average age for patients was 63.81±12.48yrs, 73.4% were male and 27% had DM at the time of presentation. Patient ethnicity was distributed as 407 (31%) SA and 896 (69%) WNA. DM was significantly more frequent in SA compared with WNA (34% vs. 24%, p<0.01). In the DM cohort, SA were more likely to have multivessel disease on coronary angiography (SA 55% vs. WNA 44%, p=0.04), and had significantly increased mortality (SA 14% vs. WNA 7%, p=0.04) and mortality/MACE (SA 22% VS. WNA 12%, p<0.01) one-year after PPCI. In multivariate analysis of one-year outcomes amongst DM, SA ethnicity was an independent predictor of both mortality (OR 2.82, 95% CI 1.15, 6.89) and mortality/MACE (OR 2.62, 95% CI 1.33, 5.16). In the non-DM cohort, SA ethnicity was not associated with outcomes or presence of multivessel disease. In conclusion, SA compared to WNA with STEMI were more likely to have DM, while SA ethnicity amongst DM patients conferred worsened one-year prognosis for cardiovascular outcomes.