Survival after acute myocardial infarction in Asian and white patients in Birmingham.

Mukhtar, H; Littler, W. A.

doi:10.1136/hrt.73.2.122

Cited by 27 publications

(24 citation statements)

References 3 publications

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“…These studies included small numbers of South Asian patients, which may have limited their ability to detect differences. 11,12,28 The results of the present analysis are also consistent with findings in peritoneal dialysis patients, another high-cardiovascular-risk population; Hemmelgarn identified a 37% lower long-term mortality among South Asian patients rela-tive to white patients 29 and in patients hospitalized for heart failure. 30 Moreover, the lower long-term mortality observed among South Asians in our study is not likely due to artifact given the control for numerous confounding factors, including SES, and the sensitivity analyses controlling for revascularization and extent of coronary disease among those with diagnostic coronary catheterization.…”

Section: Discussionsupporting

confidence: 79%

“…Several studies have demonstrated similar infarct size and type of AMI between these 2 groups. 11,12,28 In our study, South Asian AMI patients had significantly lower long-term mortality. Early revascularization is associated with reduced long-term cardiovascular outcomes after AMI.…”

Section: Discussionmentioning

confidence: 68%

“…Others have also found similar or greater use of cardiac catheterization and revascularization among South Asian patients compared with white patients. 28,39 Nevertheless, the higher rate of cardiac catheterization may signal that cardiologists are aware of the higher prevalence of coronary disease in this group and may provide more aggressive care. 40 In a study of elderly AMI survivors in British Columbia, South Asian and Chinese patients were as likely or more likely to be prescribed secondary prevention therapy as their white counterparts.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes After Acute Myocardial Infarction in South Asian, Chinese, and White Patients

et al. 2010

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Background-Cardiac mortality rates vary substantially between countries and ethnic groups. It is unclear, however, whether South Asian, Chinese, and white populations have a variable prognosis after acute myocardial infarction (AMI).To clarify this association, we compared mortality, use of revascularization procedures, and risk of recurrent AMI and hospitalization for heart failure between these ethnic groups in a universal-access healthcare system. Methods and Results-We used a population cohort study design using hospital administrative data linked to cardiac procedure registries from British Columbia and the Calgary Health Region Area in Alberta (1994Alberta ( to 2003 to identify AMI cases. Patient ethnicity was categorized using validated surname algorithms. There were 2190 South Asian, 946 Chinese, and 38479 white patients with AMI identified. There was no significant difference in use of revascularization procedures between ethnic groups at 30 d and 1 year. Short-term (30-day) mortality was higher among Chinese relative to white patients (odds ratio, 1.23; 95% confidence interval, 1.02 to 1.48). There was no significant difference in 30-day mortality between South Asian and white patients. South Asian patients had a 35% lower relative risk of long-term mortality compared with white patients (hazard ratio, 0.65; 95% confidence interval, 0.57 to 0.72). There was no significant difference in long-term mortality between Chinese and white patients. Among AMI survivors, Chinese patients had a lower risk of recurrent AMI, whereas there was no difference between South Asian and white patients. Conclusion-The ethnic groups studied have striking differences in outcomes after AMI, with South Asian patients having significantly lower long-term mortality after AMI. (Circulation. 2010;122:1570-1577.)

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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Outcomes After Acute Myocardial Infarction in South Asian, Chinese, and White Patients

et al. 2010

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“…Furthermore, mortality from coronary heart disease in this group is higher than in the indigenous white Caucasian population, as is the incidence of a further coronary event after the first myocardial infarction [2] . Although the North American literature describes racial differences in the use of invasive procedures in the management of cardiac disease, including coronary artery bypass grafting [2][3][4] , the experience in the United Kingdom does not reflect these differences [2,[5][6][7] . Dissimilarities in the management of cardiac disease, therefore, cannot fully explain the higher mortality in the Indo-Asian ethnic group.…”

Section: Introductionmentioning

confidence: 99%

Comparison of primary coronary artery bypass surgery in a British Indo-Asian and white Caucasian population

Goldsmith

Lip²,

Tsang³

et al. 1999

European Heart Journal

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Aim To compare the clinical characteristics, at the time of admission and after coronary revascularization by bypass surgery, among British patients of Indo-Asian and white Caucasian descent.Method One hundred and ninety-four pairs of patients admitted between November 1994 and January 1997 were matched for age (within 3 years), sex and date of admission (within 3 months). Their clinical characteristics at the time of admission for coronary artery bypass grafting surgery, and the incidence of hospital morbidity, hospital mortality and length of stay in the intensive therapy unit or hospital following coronary artery bypass grafting were determined.Results A higher proportion of Indo-Asian patients underwent coronary revascularization on a non-elective basis (43% vs 32% white Caucasian patients, P=0·018), had a higher prevalence of diabetes (39% vs 12%, P=0·0001), a lower prevalence of smoking (36% vs 80%, P=0·0001) and a lower rate of previous myocardial infarction (47% vs 62%, P=0·012). As regards revascularization, although there was no significant difference in the number of vessels revascularized, there was a lower use of the arterial conduit (internal mammary artery) in the Indo-Asian patients (72% vs 81%, P=0·028) particularly for those undergoing emergency/urgent surgery (59% vs 72%, P=0·001) and with a previous myocardial infarction (65% vs 81%; P=0·01) when compared with their white Caucasian counterparts. Following surgery there were no differences in the types of support required for vital functions. There was no significant difference in the proportion of major post-operative complications, that is, haemorrhage, cerebrovascular accident, renal failure requiring dialysis or respiratory failure. Similarly, there were no differences in the length of intensive therapy unit stay (median stay 1 day vs 1 day, P=0·4) and hospital stay following surgery (median stay 6 days vs 6 days, P=0·5) between the two groups. Although there was a trend towards a higher in-hospital (30 day) mortality (6·7% [95% confidence intervals CI 3·18-10·21] vs 2·6% [CI 0·35-4·9; P=0·0618]), in Indo-Asians compared to white Caucasians this trend disappeared when patients in the two groups undergoing non-elective surgery only were compared (9% vs 7%; P=0·7).Conclusions A higher proportion of Indo-Asians underwent non-elective coronary revascularization, with a significantly lower use of the arterial conduit and a relatively higher in-hospital mortality. Following coronary revascularization the medical management, length of stay and hospital morbidity in Indo-Asian patients was no different from that of their white Caucasian counterparts. This is despite a perceived poorer outcome in Indo-Asians compared to white Caucasians.

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“…Gupta et al (7) showed similar rates of in-hospital mortalities among SA and non-SA patients admitted for myocardial infarction (MI). Other studies examining long-term outcomes of SA patients were completed before the era of aggressive coronary intervention and potent antiplatelet therapies (8,9). It is unclear whether the long-term outcomes of SAs are similar to those of the non-SAs with ACS in this contemporary era.…”

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confidence: 99%

Long-term prognosis of south Asians following acute coronary syndromes

Raghavan

Rahme

Nedjar

et al. 2008

Canadian Journal of Cardiology

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Survival after acute myocardial infarction in Asian and white patients in Birmingham.

Abstract: The survival and clinical course of South Asian and white patients discharged after an acute myocardial infarction were similar over a four year period.

Cited by 27 publications

References 3 publications

Outcomes After Acute Myocardial Infarction in South Asian, Chinese, and White Patients

Outcomes After Acute Myocardial Infarction in South Asian, Chinese, and White Patients

Comparison of primary coronary artery bypass surgery in a British Indo-Asian and white Caucasian population

Long-term prognosis of south Asians following acute coronary syndromes

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