Evidence map›Paper›PMID 30867199›Full record

ArticleBMJ open2019

Acute coronary syndromes presentations and care outcomes in white, South Asian and Chinese patients: a cohort study.

Kathryn King-Shier, Hude Quan, M K Kapral, Ross Tsuyuki, Libin An, Suvro Banerjee, Danielle A Southern, Nadia Khan

Open access · goldAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed
3.4field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 36 citations in OpenAlex.

  1. Article
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  6. Article
  7. Comparative Analysis of Patients With STEMI and COVID-19 Between Canada and the United States.Journal of the Society for Cardiovascular Angiography & Interventions · 2023
    Article
  8. Article
  9. Article
  10. Article
  11. Review
  12. Racial and Ethnic Disparities in Acute Coronary Syndrome: A Nationally Representative Sample.Journal of the Society for Cardiovascular Angiography & Interventions
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 8 countries.

Kathryn King-ShierNursing, University of Calgary, Calgary, Alberta, Canada.
Hude QuanCommunity Health Sciences, University of Calgary, Calgary, Alberta, Canada.ORCID 0000-0002-7848-7256
M K KapralDepartment of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada.
Ross TsuyukiFaculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Libin AnSchool of Nursing, Dalian University, Dalian, China.
Suvro BanerjeeCardiology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India.
Danielle A SouthernCommunity Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Nadia KhanMedicine, University of British Columbia, Vancouver, British Columbia, Canada.
University of Calgary · CAApollo Gleneagles Hospitals · INDalian University · CNUniversity of Alberta · CAUniversity of British Columbia · CAUniversity of Toronto · CA

Funding

CIHR
6 · The paper itself

Abstract

objectivesSuccessful treatment of acute coronary syndrome (ACS) relies on its rapid recognition. It is unclear whether the accepted presentation of chest pain applies to different ethnic groups. We thus examined potential ethnic variations in ACS symptoms and clinical care outcomes in white, South Asian and Chinese patients.

designCross-sectional survey.

settingParticipants were hospitalised at 1 of 12 Canadian centres across four provinces.

participants1334 patients with ACS (630 white; 488 South Asian; 216 Chinese).

main outcome measuresACS presentation symptoms (classic/typical midsternal pain/discomfort with or without radiation to the left neck, shoulder or arm) were assessed by self-report. Clinical care outcomes (time to emergency room [ER] presentation, cardiac catheterisation; receipt of cardiac catheterisation, percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) were obtained by health record audit.

resultsThe mean age of the sample was 62 years and 30% had ST-elevation myocardial infarction (STEMI). The most common presenting symptom was midsternal pain/discomfort of any intensity regardless of ethnic status. Yet, a substantial proportion of patients reported atypical symptoms (33% white, 19% South Asian, 20% Chinese; p<0.006). After adjustment for age, sex, education, current smoking, extent of coronary artery disease, presence of diabetes or chronic kidney disease and STEMI vs non-STEMI/unstable angina, South Asians were more likely to present with at least moderate intensity midsternal pain/discomfort (adjusted OR [AOR] 1.44; 95% CI 1.05 to 1.98), whereas Chinese were less likely to present with radiating symptoms (AOR 0.53; 95% CI 0.38 to 0.74) compared with whites. South Asians with atypical pain (relative to those with midsternal pain/discomfort) took significantly longer to present to the ER (p=0.037), and were less likely to receive PCI (p=0.008) or CABG (p=0.041).

conclusionsAtypical presentations were associated with greater delays in arrival to the emergency department and reduced invasive cardiovascular care in South Asians.

Indexed as

Asian PeopleWhite PeopleAcute Coronary SyndromeAgedCanadaChinaCohort StudiesCoronary Artery BypassCross-Sectional StudiesFemaleHospitalizationHumansLogistic ModelsMaleMiddle AgedPercutaneous Coronary Interventionacute coronary syndromecare accessethnicitysymptoms

Identifiers

PMID30867199
PMCPMC6429729
OpenAlexW2921064050

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.