Abstract 15543: Geographic Variations of Coronary Atheroma Progression and Clinical Events in Patients With Coronary Artery Disease (CAD)
Background: As enrollment in cardiovascular clinical trials becomes more global, atherosclerotic risk factors and treatment strategies can vary per region, affecting clinical outcomes. We characterized coronary atheroma progression and clinical event rates of CAD patients in North America (NA) and in other global regions.
Methods: Coronary atheroma progression and major adverse cardiovascular events (MACE: death, myocardial infarction, coronary revascularization) were evaluated in 5477 patients in 7 clinical trials employing serial IVUS. Disease progression, measured as change in percent atheroma volume (PAV), and MACE rates of patients in differing regions [NA, (n=4177); Latin America (LA, n=361); Western Europe (WE, n=618); and Central-Eastern Europe (C-EE, n=321)] were characterized.
Results: Compared to each region, NA patients had higher baseline levels of BMI (p<0.001), triglycerides (p<0.001) and CRP (p<0.001), but lower levels of LDL-C (p<0.001) and HDL-C (p<0.001). While baseline PAV across regions was similar (p=0.37), PAV progression was most frequent in NA patients (p<0.001), who also showed the greatest PAV progression compared to other regions (p=0.009). Following multivariable adjustment of clinical, laboratory and IVUS variables, and after controlling for trial, a NA location independently predicted PAV progression (p<0.001) and MACE [HR 1.60, 95% CI (1.25, 2.06), p<0.001] compared to all regions. Kaplan-Meier estimates by region outline significantly higher MACE rates in NA patients (log-rank p<0.001) (Figure), driven largely by the rate of coronary revascularization procedures.
Conclusions: North American patients with CAD show greater coronary atheroma progression and higher MACE rates than their global counterparts, experiencing more frequent coronary revascularization. These findings have broad implications for clinical trial design, treatment guidelines and global health policy.
- © 2013 by American Heart Association, Inc.