title: Declining case fatality rates for acute myocardial infarction in South Asian and white patients in the past 15 years.
abstract: OBJECTIVE
  To determine whether case fatality rates in South Asian (Bangladeshi, Indian and Pakistani) patients with acute myocardial infarction have shown similar declines to those reported for white patients during the past 15 years.
  
  
  METHODS
  Cross-sectional, observational study.
  
  
  METHODS
  Coronary care unit in east London.
  
  
  METHODS
  2640 patients-29% South Asian-admitted with acute myocardial infarction between January 1988 and December 2002.
  
  
  METHODS
  Differences over time in rates of in-hospital death, ventricular fibrillation and left ventricular failure.
  
  
  RESULTS
  The proportion of South Asians increased from 22% in 1988-92 to 37% in 1998-2002. Indices of infarct severity were similar in South Asian and white patients, with declining frequencies of ST elevation infarction (88.2% to 77.5%, p < 0.0001), Q wave development (78.1% to 56.9%, p < 0.0001) and mean (interquartile range) peak serum creatine kinase concentrations (1250 (567-2078) to 1007 (538-1758) IU/l, p < 0.0001) between 1988-92 and 1998-2002. Rates of in-hospital death (13.0% to 9.4%, p < 0.01), ventricular fibrillation (9.2% to 6.0%, p < 0.001) and left ventricular failure (33.2% to 26.5%, p < 0.0001) all declined; these changes did not interact significantly with ethnicity. Odds ratios for the effect of time on risk of death increased from 0.81 (95% CI 0.70 to 0.93) to 1.02 (95% CI 0.87 to 1.21) after adjustment for ethnicity and indices of infarct severity (ST elevation, peak creatine kinase, Q wave development and treatment with a thrombolytic).
  
  
  CONCLUSIONS
  In the past 15 years, death from acute myocardial infarction among South Asians has declined at a rate similar to that seen in white patients. This is largely caused by reductions in indices of infarct severity.
authors.affiliation: Barts and the Royal London NHS Trust, St Bartholomew's Hospital, London EC1A 7BE, UK. r.liew@imperial.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Liew
authors.forename: S
authors.initials: S
authors.lastname: Sulfi
authors.forename: K
authors.initials: K
authors.lastname: Ranjadayalan
authors.forename: J
authors.initials: J
authors.lastname: Cooper
authors.forename: A D
authors.initials: AD
authors.lastname: Timmis
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality*; D011379:Prognosis; D014693:Ventricular Fibrillation / Q000208:ethnology / Q000401:mortality; D044465:White People / Q000706:statistics & numerical data*