Comparing Coronary Atheroma Progression Rates and Coronary Events in the United States, Canada, Latin America, and Europe.
We explored for geographic variations in coronary atheroma progression rates in the United States compared to other world regions (Canada, Latin America, Western Europe, and Central-Eastern Europe) and sought to ascertain if this associated with regional differences in major adverse cardiovascular events (MACE; cardiovascular death, nonfatal myocardial infarction, coronary revascularization). Across 7 randomized trials with a global recruitment pattern, 5,451 participants with angiographic coronary disease underwent serial coronary intravascular ultrasonography during 18 or 24 months, with adjudicated MACE. Change in coronary percent atheroma volume (ΔPAV) and MACE in the United States versus other world regions were assessed. Despite similar baseline angiographic and plaque characteristics across participants and regions, following propensity-weighted and multivariate analysis, US (n = 3,706) versus non-US (n = 1,745) participants demonstrated marginal but significantly greater annualized ΔPAV (least-square means ± SE: 0.27 ± 0.14% vs 0.062 ± 0.14%, p = 0.005). However, MACE rates were disproportionately higher in US compared to non-US participants (23.5% vs 10.9%, p <0.001), driven by a doubling in crude rates of coronary revascularization procedures (16.1% vs 7.8%, p <0.001). The US participants hospitalized with unstable angina demonstrated more significant disease progression than their non-US counterparts (ΔPAV: 0.57 ± 0.19% vs -0.30 ± 0.36%, p = 0.033) and greater MACE (9.1% vs 4.8%, p <0.001). A US geographic disposition independently associated with MACE (hazard ratio 1.53, 95% confidence interval 1.22 to 1.92, p <0.001). In conclusion, in participants with stable coronary disease, coronary atheroma progression rates are modestly higher in US-based compared to non-US-based participants. Elective coronary revascularization rates however are disproportionately greater in US-based participants.
Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio; Department of Medicine, University of Adelaide, Adelaide, Australia.
Rishi
R
Puri
South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
Stephen J
SJ
Nicholls
Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio.
Julie
J
St John
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
E Murat
EM
Tuzcu
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
Samir R
SR
Kapadia
Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio.
Kiyoko
K
Uno
South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
Yu
Y
Kataoka
Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio.
Kathy
K
Wolski
Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: nissens@ccf.org.
Steven E
SE
Nissen
D002170:Canada / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000453:epidemiology; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional / Q000379:methods*; D014481:United States / Q000453:epidemiology