CARDIOVASCULAR MEDICINE

Declining case fatality rates for acute myocardial infarction in South Asian and white patients in the past 15 years

R Liew¹, S Sulfi², K Ranjadayalan², J Cooper³, A D Timmis⁴

¹ Barts and the Royal London NHS Trust, London, UK
² Newham University Hospital NHS Trust, Plaistow, London, UK
³ Royal Free and University College Medical School, London, UK
⁴ London Chest Hospital, London, UK

Correspondence to:
Dr Reginald Liew
Barts and the Royal London NHS Trust, St Bartholomew’s Hospital, London EC1A 7BE, UK; r.liew{at}imperial.ac.uk

Objectives: 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.

Design: Cross-sectional, observational study.

Setting: Coronary care unit in east London.

Patients: 2640 patients—29% South Asian—admitted with acute myocardial infarction between January 1988 and December 2002.

Main outcome measures: 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.

Keywords: acute myocardial infarction; South Asians; ethnicity; mortality

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