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CC BY 4.0 · Thromb Haemost 2024; 124(06): 501-516
DOI: 10.1055/s-0043-1777794
Coagulation and Fibrinolysis

Ethnic Differences in Thrombotic Profiles of Acute Coronary Syndrome Patients and Relationship to Cardiovascular Outcomes: A Comparison of East Asian and White subjects

Jung-Won Suh
1   Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
,
Vassilios Memtsas
2   Cardiovascular Division, Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
,
Ying X Gue
3   Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
,
Hyoung-Won Cho
1   Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
,
Wonjae Lee
1   Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
,
Si-Hyuck Kang
1   Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
,
Diana A. Gorog 
2   Cardiovascular Division, Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
4   Centre for Health Services and Clinical Research, Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom
› Author Affiliations Funding This study was in part supported by a grant from the Science Research Program through the National Research Foundation of Korea and a grant from Korean Society of Interventional Cardiology (NRF-2020R1F1A1075503 and KSIC 2019-02).
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Abstract

Background East Asians (EAs), compared to white Caucasians (W), have a lower risk of ischemic heart disease and a higher risk of bleeding with antithrombotic medications. The underlying mechanisms are incompletely understood.

Objectives We sought to compare thrombotic profiles of EA and W patients with myocardial infarction (MI) and relate these to cardiovascular outcomes.

Methods In a prospective study in the United Kingdom and Korea, blood samples from patients (n = 515) with ST- or non-ST-elevation MI (STEMI and NSTEMI) were assessed using the Global Thrombosis Test, measuring thrombotic occlusion (OT) and endogenous fibrinolysis (lysis time [LT]). Patients were followed for 1 year for major adverse cardiovascular events (MACE) and bleeding.

Results EA patients showed reduced OT (longer OT) compared to W (646 seconds [470–818] vs. 436 seconds [320–580], p < 0.001), with similar LT. In STEMI, OT (588 seconds [440–759] vs. 361 seconds [274–462], p < 0.001) and LT (1,854 seconds [1,389–2,729] vs. 1,338 seconds [1,104–1,788], p < 0.001) were longer in EA than W. In NSTEMI, OT was longer (OT: 734 seconds [541–866] vs. 580 seconds [474–712], p < 0.001) and LT shorter (1519 seconds [1,058–2,508] vs. 1,898 seconds [1,614–2,806], p = 0.004) in EA than W patients. MACE was more frequent in W than EA (6.3 vs. 1.9%, p = 0.014) and bleeding infrequent. While OT was unrelated, LT was a strong independent predictor of MACE event after adjustment for risk factors (hazard ratio: 3.70, 95% confidence interval: 1.43–9.57, p = 0.007), predominantly in W patients, and more so in STEMI than NSTEMI patients.

Conclusion EA patients exhibit different global thrombotic profiles to W, associated with a lower rate of cardiovascular events.

Keywords

myocardial infarction - ethnicity - thrombotic status - fibrinolysis - East Asian

Supplementary Material



Publication History

Received: 26 May 2023

Accepted: 27 October 2023

Article published online:
29 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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