Am J Cardiovasc Dis 2011;1(1):31-37

Original Article
Quantitative angiography in south Asians reveals differences in vessel size
and coronary artery disease severity compared to Caucasians

Rani K. Hasan, Naeema T. Ginwala, Rhia Y. Shah, Dharam J. Kumbhani, Robert L. Wilensky, Nehal N. Mehta

Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA; Division of Cardiovascular Medicine, Section of
Preventive Cardiology and The Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of
Medicine; Divison of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA,

Received March 28, 2011; accepted April 15, 2011; Epub April 20, 2011; published June 1, 2011

Abstract: Background:  South Asians are one of the highest risk ethnic groups for development of coronary artery disease
(CAD) mortality and morbidity. Previous studies have investigated whether South Asians exhibit differences in angiographic
coronary artery disease compared to Caucasians, with inconsistent results. Methods: We conducted a retrospective
observational study comparing South Asians undergoing cardiac catheterization at a tertiary care institution with
Caucasians who underwent catheterization at the same time and location to assess whether South Asians demonstrated
smaller coronary artery size and/or increased angiographic coronary artery disease.  Demographic and laboratory data
were retrospectively abstracted. Quantitative coronary angiographic analysis of all three coronary arteries was performed
using the edge-detection method. Results: South Asian patients were younger (57 versus 64 years, p=0.004) and showed
higher prevalences of diabetes, dyslipidemia, and acute coronary syndrome compared with Caucasians (40% versus
16%, p=0.004; 65% versus 46%, p=0.04; and 37% versus 10%, p<0.001; respectively).  South Asians exhibited smaller
normalized proximal LAD luminal diameters (1.56 versus 1.72 mm/m2, p=0.04) when compared to Caucasians.  South
Asians also displayed more severe CAD as determined by both increased mean percent stenosis in the proximal LAD and
RCA segments (22.7% versus 11.1%, p=0.004; and 24.5% versus 13.9%, p=0.0001, respectively) as well as a higher
number of patients with multiple diseased vessel segments. Conclusions: South Asians demonstrated more severe CAD
compared to Caucasians undergoing cardiac catheterization as evidenced by smaller proximal LAD luminal diameters,
higher percent stenosis per vessel, and more patients with multivessel disease.  Further study is warranted to better
define factors important in the development of CAD and inform risk stratification in this high-risk

Keywords: Coronary artery disease, South Asian, quantitative coronary angiography

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Address all correspondence to:
Rani K. Hasan, MD
Division of Cardiology
Johns Hopkins University
600 N. Wolfe St. Carnegie 568
Baltimore, MD 21287, USA.
Tel: 410-614-0543, Fax: 410-614-9990
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