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Canadian Journal of Cardiology

CARDIOVASCULAR OUTCOMES OF ACUTE CORONARY SYNDROMES IN INDIGENOUS COMPARED WITH NON-INDIGENOUS PATIENTS IN NORTHERN SASKATCHEWAN

      BACKGROUND

      Indigenous compared with non-Indigenous patients have historically been known to have higher cardiovascular risk. With improved care delivery of acute myocardial infarction, we sought to compare contemporary profiles between indigenous versus non-Indigenous patients presenting with acute coronary syndromes (ACS) to a single PCI cardiac center in Saskatchewan.

      METHODS AND RESULTS

      We prospectively evaluated consecutive ACS admissions (no exclusion criteria applied) from March 15, 2019 to March 30, 2021 at the Royal University Hospital, Saskatoon. Categorized by self-reported Indigenous and non-Indigenous status, we describe presenting demographics, treatment patterns, unadjusted all-cause mortality and all-cause rehospitalization. Continuous variables are presented as medians (25th, 75th percentiles), categorical values as frequencies (%). Of the 1950 ACS admissions, 260 (13.3%) were Indigenous. Indigenous compared with non-Indigenous patients were younger, more likely female, have a history of heart failure and a significant burden of both traditional and non-traditional cardiovascular risk factors. Both groups were revascularized comparably with PCI. Indigenous compared with non-Indigenous patients were however more likely to present with higher levels of NTproBNP and higher incident rates of cardiogenic shock and/or cardiac arrest, with a greater severity of left ventricular systolic dysfunction (Table 1). While in-hospital mortality is comparable between the two groups, Indigenous compared with non-Indigenous have significantly higher unadjusted 1-year mortality (11.9% vs. 8.0%, p= 0.039).

      CONCLUSION

      Indigenous compared with non-Indigenous patients hospitalized with an acute coronary syndrome have a significantly greater burden of premorbid cardiovascular risk and present with greater clinical acuity. While the in-hospital outcomes are comparable, likely due to established pre-hospital/in-hospital ACS processes of care, the higher one-year mortality suggest that the higher residual risk in Indigenous patients is likely driven by the greater burden of modifiable traditional and non-traditional risk factors in this patient population.
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