title: Ethnic differences in acute myocardial infarction in Singapore.
abstract: OBJECTIVE
  We compare the myocardial infarction (MI) event and mortality rates among Chinese, Malay and Indian residents of Singapore.
  
  
  METHODS
  Residents, aged 20 to 64 years, with an MI event were identified from hospital discharge listings, postmortem reports, and the Registry of Births and Deaths. All pathology laboratories flagged patients with elevated creatine phosphokinase (CPK) levels. Modified MONICA (multinational monitoring of trends and determinants in cardiovascular disease) criteria were used for determining MI events.
  
  
  RESULTS
  From 1991 to 1999, 12 481 MI events were identified. Chinese patients were older and less likely to have typical symptoms or previous MI. Malays had the highest peak CPK level. Among all three ethnic groups, MI event and age-adjusted case-fatality rates declined. Compared with Chinese, MI event rates were >2-fold and >3-fold higher, and age-standardized coronary mortality rates were 2.4 and 3.0 higher times for Malays and Indians, respectively. Malays have the highest 3.1-year case-fatality, with an adjusted hazard ratio of 1.26 (95% confidence interval, 1.14 to 1.38) compared with Chinese.
  
  
  CONCLUSIONS
  We found strong ethnic differences in MI event, case-fatality and coronary mortality rates among the three ethnic groups in Singapore. While Indians have the greatest MI event rates, Malays have the highest case-fatality.
authors.affiliation: Department of Cardiology, National Heart Centre, Singapore.
authors.forename: K-H
authors.initials: KH
authors.lastname: Mak
authors.forename: K-S
authors.initials: KS
authors.lastname: Chia
authors.forename: J D
authors.initials: JD
authors.lastname: Kark
authors.forename: T
authors.initials: T
authors.lastname: Chua
authors.forename: C
authors.initials: C
authors.lastname: Tan
authors.forename: B-H
authors.initials: BH
authors.lastname: Foong
authors.forename: Y-L
authors.initials: YL
authors.lastname: Lim
authors.forename: S-K
authors.initials: SK
authors.lastname: Chew
mesh_terms: D000328:Adult; D017677:Age Distribution; D002681:China / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology* / Q000401:mortality; D012846:Singapore / Q000453:epidemiology; D016019:Survival Analysis; D015996:Survival Rate