title: Ethnic differences in clinical outcome of patients presenting to the emergency department with chest pain.
abstract: BACKGROUND
  Ethnicity, although known to influence cardiovascular outcome in assorted clinical settings, has not been investigated previously as a risk factor in patients presenting to the emergency department with suspected acute myocardial infarction.
  
  
  METHODS
  In this multi-ethnic cohort study conducted in Singapore and The Netherlands, 2784 patients presenting to the emergency department with chest pain were enrolled (788 Caucasians, 1281 Chinese, 404 Indians and 311 Malays) and were followed up for 1 year.
  
  
  RESULTS
  Although Caucasian patients on average were older and had incurred more cardiovascular adverse events, the Asian ethnic groups carried a greater burden of cardiovascular risk factors. Caucasian and Malay patients were most frequently diagnosed with acute myocardial infarction (Caucasians 11.2%, Chinese and Indians 6.4%, Malays 10.6%, P<0.001), also after correction for baseline differences. Chinese and Indian patients, however, more often had unstable angina. Asian patients had strikingly more extensive coronary artery disease than Caucasian patients (triple-vessel disease: Caucasians 6.5%, Chinese 22.8%, Indians 32.4%, Malays 32.8%, P<0.001) and Chinese patients with myocardial infarction more frequently underwent coronary revascularisation compared with Caucasian patients (Caucasians 41.4%, Chinese 67.5%, Indians 62.5%, Malay 46.7%, P=0.005). Ethnicity was not an independent predictor of major adverse cardiovascular events during 1-year follow-up in all chest pain patients.
  
  
  CONCLUSIONS
  The prevalence of myocardial infarction and unstable angina, revascularisation rate and extent of coronary artery disease differ significantly among chest pain patients of different ethnic groups. These findings have important clinical implications and support consideration of ethnicity in risk stratification and determination of the patient management strategy in patients with symptoms suggestive of myocardial infarction.
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands.|2 ICIN - Netherlands Heart Institute, The Netherlands.|3 Department of Medicine, National University of Singapore, Singapore.
authors.forename: Vince C
authors.initials: VC
authors.lastname: de Hoog
authors.affiliation: 4 Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Swee Han
authors.initials: SH
authors.lastname: Lim
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands.|5 Department of Cardiology, Meander Medical Center, The Netherlands.
authors.forename: Ingrid Em
authors.initials: IE
authors.lastname: Bank
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands.|2 ICIN - Netherlands Heart Institute, The Netherlands.
authors.forename: Crystel M
authors.initials: CM
authors.lastname: Gijsberts
authors.affiliation: 6 Department of Emergency Medicine, National University Hospital, Singapore.
authors.forename: Irwani B
authors.initials: IB
authors.lastname: Ibrahim
authors.affiliation: 6 Department of Emergency Medicine, National University Hospital, Singapore.
authors.forename: Win Sen
authors.initials: WS
authors.lastname: Kuan
authors.affiliation: 6 Department of Emergency Medicine, National University Hospital, Singapore.
authors.forename: Shirley Bs
authors.initials: SB
authors.lastname: Ooi
authors.affiliation: 7 National Heart Center Singapore, Singapore.
authors.forename: Terrance
authors.initials: T
authors.lastname: Chua
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands.
authors.forename: Hester M
authors.initials: HM
authors.lastname: den Ruijter
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands.|8 Department of Clinical Chemistry and Hematology, UMC Utrecht, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
authors.affiliation: 3 Department of Medicine, National University of Singapore, Singapore.
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.affiliation: 7 National Heart Center Singapore, Singapore.|9 Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Fei
authors.initials: F
authors.lastname: Gao
authors.affiliation: 10 Department of Cardiology, UMC Utrecht, The Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.affiliation: 5 Department of Cardiology, Meander Medical Center, The Netherlands.
authors.forename: Thierry X
authors.initials: TX
authors.lastname: Wildbergh
authors.affiliation: 5 Department of Cardiology, Meander Medical Center, The Netherlands.|10 Department of Cardiology, UMC Utrecht, The Netherlands.
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
authors.affiliation: 11 Medicine NUS and Cardiovascular Research Institute, NUHS, Singapore.|12 Christchurch Heart Institute, University of Otago, New Zealand.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands.|2 ICIN - Netherlands Heart Institute, The Netherlands.|13 Surgery NUS and Cardiovascular Research Institute, NUHS, Singapore.
authors.forename: Dominique Pv
authors.initials: DP
authors.lastname: de Kleijn
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands.|10 Department of Cardiology, UMC Utrecht, The Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Timmers
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology*; D002637:Chest Pain / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology*; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology
keywords: Ethnicity; chest pain; coronary artery disease; major adverse cardiac events; myocardial infarction; outcome