Contemporary Outcomes of Acute Coronary Syndromes in Indigenous Compared with Non-Indigenous Patients: A Northern Saskatchewan Perspective

Jay S Shavadia; Udoka Okpalauwaekwe; Minyoung Kim; Jason Orvold; Colin Pearce; Alexandra King; Kehinde Ametepee; Haissam Haddad

doi:10.1016/j.cjca.2024.04.025

Contemporary Outcomes of Acute Coronary Syndromes in Indigenous Compared with Non-Indigenous Patients: A Northern Saskatchewan Perspective

Can J Cardiol. 2024 May 8:S0828-282X(24)00354-4. doi: 10.1016/j.cjca.2024.04.025. Online ahead of print.

Authors

Jay S Shavadia¹, Udoka Okpalauwaekwe², Minyoung Kim³, Jason Orvold⁴, Colin Pearce⁴, Alexandra King⁵, Kehinde Ametepee⁶, Haissam Haddad⁴

Affiliations

¹ Department of Medicine, Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan. Electronic address: iss372@usask.ca.
² Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan.
³ Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan.
⁴ Department of Medicine, Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan.
⁵ Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan; Pewaseskwan Indigenous Wellness Research Group, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan.
⁶ Pewaseskwan Indigenous Wellness Research Group, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan.

PMID: 38729604
DOI: 10.1016/j.cjca.2024.04.025

Abstract

Background: In patients presenting with an acute coronary syndrome (ACS), the impact of efforts leveraged at bridging historical care gaps between Indigenous and non-Indigenous patients remains limited.

Methods: For consecutive ACS presentations (STEMI and NSTEMI/UA, respectively) at the Royal University Hospital, Saskatoon, we compared between self-identified Indigenous and non-Indigenous patients their demographics, treatments and all-cause mortality (in-hospital and 3-years). We used propensity score-inverse probability weighting to mitigate confounding, and Cox regression models to estimate the adjusted hazard (aHR, 95% confidence intervals) for all-cause mortality.

Results: Of 3946 ACS patients, 37.2% (n=1468) were STEMI of whom 11.3% (n=166) were Indigenous. Of the NSTEMI/UA (n=2478), 12.6% (n=311) were Indigenous. Overall, Indigenous compared with non-Indigenous patients were likely to be younger, female, have higher risk burden, and lived more remotely; Indigenous STEMI patients triaged to primary PCI had longer first medical contact-to-device times, while Indigenous NSTEMI/UA patients more likely to present with heart failure, cardiac arrest and/or cardiogenic shock. No significant differences were noted for in-hospital mortality (STEMI 8.4% vs 5.7%, p= 0.16; NSTEMI/UA 1.9% vs 1.6%, p=0.68), however, in follow-up, Indigenous STEMI patients associated with a higher all-cause mortality risk (aHR 1.98, 95% CI 1.19, 3.31, p=0.009) with no between-group differences evident for NSTEMI/UA (aHR 1.03, 95% CI 0.63 1.69, p=0.91).

Conclusions: Indigenous compared with non-Indigenous patients presenting with an ACS had higher cardiovascular risk profiles, and consequently residual mortality risk. Improving primary care and intensifying secondary risk reduction, and particularly so for Indigenous patients, will substantially modify ACS outcomes in Saskatchewan.

Keywords: Acute Coronary Syndromes; All-cause mortality; Indigenous health; Non-STEMI/unstable angina (NSTEMI/UA); ST-segment elevation myocardial infarction (STEMI).