Vince C de Hoog1,2,3, Swee Han Lim4, Ingrid Em Bank1,5, Crystel M Gijsberts1,2, Irwani B Ibrahim6, Win Sen Kuan6, Shirley Bs Ooi6, Terrance Chua7, Hester M den Ruijter1, Gerard Pasterkamp1,8, E Shyong Tai3, Fei Gao7,9, Pieter A Doevendans10, Thierry X Wildbergh5, Arend Mosterd5,10, A Mark Richards11,12, Dominique Pv de Kleijn1,2,13, Leo Timmers1,10. 1. 1 Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands. 2. 2 ICIN - Netherlands Heart Institute, The Netherlands. 3. 3 Department of Medicine, National University of Singapore, Singapore. 4. 4 Department of Emergency Medicine, Singapore General Hospital, Singapore. 5. 5 Department of Cardiology, Meander Medical Center, The Netherlands. 6. 6 Department of Emergency Medicine, National University Hospital, Singapore. 7. 7 National Heart Center Singapore, Singapore. 8. 8 Department of Clinical Chemistry and Hematology, UMC Utrecht, The Netherlands. 9. 9 Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore. 10. 10 Department of Cardiology, UMC Utrecht, The Netherlands. 11. 11 Medicine NUS and Cardiovascular Research Institute, NUHS, Singapore. 12. 12 Christchurch Heart Institute, University of Otago, New Zealand. 13. 13 Surgery NUS and Cardiovascular Research Institute, NUHS, Singapore.
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.
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 painpatients. CONCLUSIONS: The prevalence of myocardial infarction and unstable angina, revascularisation rate and extent of coronary artery disease differ significantly among chest painpatients 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.