title: Differences in late cardiovascular mortality following acute myocardial infarction in three major Asian ethnic groups.
abstract: OBJECTIVE
  the purpose of this study was to investigate differences in long-term mortality following acute myocardial infarction (AMI) in patients from three major ethnicities of Asia.
  
  
  RESULTS
  We studied 15,151 patients hospitalized for AMI with a median follow-up of 7.3 years (maximum 12 years) in six publicly-funded hospitals in Singapore from 2000-2005. Overall and cause-specific cardiovascular (CV) mortality until 2012 were compared among three major ethnic groups that represent large parts of Asia: Chinese, Malay and Indian. Relative survival of all three ethnic groups was compared with a contemporaneous background reference population using the relative survival ratio (RSR) method. The median global registry of acute coronary events score was highest among Chinese, followed by Malay and Indians: 144 (25th percentile 119, 75th percentile 173), 138 (115, 167), and 131 (109, 160), respectively, p<0.0001; similarly, in-hospital mortality was highest among Chinese (9.8%) followed by Malay (7.6%) and Indian (6.4%) patients. In contrast, 12-year overall and cause-specific CV mortality was highest among Malay (46.2 and 32.0%) followed by Chinese (43.0 and 27.0%) and Indian (35.9 and 25.2%) patients, p<0.0001. The five-year RSR was lowest among Malay (RSR 0.69) followed by Chinese (RSR 0.73) and Indian (RSR 0.79) patients, compared with a background reference population (RSR 1.00).
  
  
  CONCLUSIONS
  We observed strong inter-Asian ethnic disparities in long-term mortality after AMI. Malay patients had the most discordant relationship between baseline risk and long-term mortality. Intensified interventions targeting Malay patients as a high-risk group are necessary to reduce disparities in long-term outcomes.
authors.affiliation: National University Heart Centre, National University of Singapore, Singapore.
authors.forename: Leonardo P
authors.initials: LP
authors.lastname: de Carvalho
authors.affiliation: National Heart Centre, Singapore Duke-NUS Graduate Medical School, Singapore.
authors.forename: Fei
authors.initials: F
authors.lastname: Gao
authors.affiliation: National Heart Centre, Singapore.
authors.forename: Qifeng
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore Department of Surgery, National University of Singapore, Singapore.
authors.forename: Mikael
authors.initials: M
authors.lastname: Hartman
authors.affiliation: National Heart Centre, Singapore.
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Sim
authors.affiliation: National Heart Centre, Singapore.
authors.forename: Tian-Hai
authors.initials: TH
authors.lastname: Koh
authors.affiliation: Tan Tock Seng Hospital, Singapore.
authors.forename: David
authors.initials: D
authors.lastname: Foo
authors.affiliation: National Heart Centre, Singapore.
authors.forename: Chee-Tang
authors.initials: CT
authors.lastname: Chin
authors.affiliation: Khoo Teck Puat Hospital, Singapore.
authors.forename: Hean-Yee
authors.initials: HY
authors.lastname: Ong
authors.affiliation: Changi General Hospital, Singapore.
authors.forename: Khim-Leng
authors.initials: KL
authors.lastname: Tong
authors.affiliation: National University Heart Centre, National University of Singapore, Singapore.
authors.forename: Huay-Cheem
authors.initials: HC
authors.lastname: Tan
authors.affiliation: National University Heart Centre, National University of Singapore, Singapore.
authors.forename: Tiong-Cheng
authors.initials: TC
authors.lastname: Yeo
authors.affiliation: National Registry of Disease Office, Health Promotion Board, Singapore.
authors.forename: Chow-Khuan
authors.initials: CK
authors.lastname: Yew
authors.affiliation: National University Heart Centre, National University of Singapore, Singapore.
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Richards
authors.affiliation: Duke Clinical Research Institute, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: National Heart Centre, Singapore.
authors.forename: Terrance
authors.initials: T
authors.lastname: Chua
authors.affiliation: National University Heart Centre, National University of Singapore, Singapore mark_chan@nuhs.edu.sg.
authors.forename: Mark Y
authors.initials: MY
authors.lastname: Chan
mesh_terms: D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D002681:China / Q000208:ethnology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology
keywords: Epidemiology; ethnic differences; outcome