Age-adjusted mortality at 1 year after ACS in South Asian compared with white patients according to demographic, risk factor, disease phenotype and management characteristics (n=203 092)
| Characteristic | South Asian | White | HR (95%CI) | p For heterogeneity |
|---|---|---|---|---|
| Whole study | 8251 (100%) | 194 841 (100%) | 0.91 (0.85 to 0.97) | |
| Demographic | ||||
| Age | ||||
| ≤60 | 3551 (43.0%) | 49 195 (25.3%) | 0.82 (0.67 to 1.01) | <0.05 |
| >60–≤70 | 2150 (26.1%) | 43 900 (22.5%) | 1.03 (0.89 to 1.19) | |
| >70–≤80 | 1884 (22.8%) | 52 503 (27.0%) | 0.91 (0.81 to 1.01) | |
| >80 | 666 (8.1%) | 49 243 (25.3%) | 0.72 (0.63 to 0.83) | |
| Sex | ||||
| Men | 6099 (73.9%) | 126 455 (64.9%) | 0.88 (0.81 to 0.96) | 0.22 |
| Women | 2152 (26.1%) | 68 386 (35.1%) | 0.96 (0.85 to 1.07) | |
| Index of Multiple Deprivation | ||||
| Q1 least deprived | 759 (9.2%) | 41 573 (21.3%) | 1.07 (0.85 to 1.34) | <0.05 |
| Q2 | 827 (10.0%) | 40 430 (20.8%) | 0.87 (0.69 to 1.10) | |
| Q3 | 1310 (15.9%) | 39 261 (20.2%) | 1.01 (0.86 to 1.19) | |
| Q4 | 1980 (24.0%) | 37 372 (19.2%) | 0.86 (0.75 to 1.00) | |
| Q5 most deprived | 3375 (40.9%) | 36 205 (18.6%) | 0.73 (0.65 to 0.82) | |
| Component group* | ||||
| Bangladeshi | 314 (7.8%) | 194 841 (100%) | 0.86 (0.61 to 1.21) | 0.68 |
| Pakistani | 1790 (44.6%) | 0.77 (0.66 to 0.91) | ||
| Indian | 1906 (47.5%) | 0.84 (0.73 to 0.96) | ||
| Ethnic density† | ||||
| Low (<0.35%) | 102 (1.2%) | 59 771 (30.7%) | 1.00 (0.57 to 1.76) | 0.94 |
| Medium | 1259 (15.3%) | 87 600 (45.0%) | 0.93 (0.78 to 1.12) | |
| High (>3.5%) | 6890 (83.5%) | 47 470 (24.4%) | 0.99 (0.91 to 1.07) | |
| Risk factors | ||||
| Smoking | ||||
| Current | 1978 (24.0%) | 55 560 (28.5%) | 0.72 (0.59 to 0.88) | <0.05 |
| Previous | 1504 (18.2%) | 70 078 (36.0%) | 0.98 (0.84 to 1.14) | |
| Never/unknown | 848 (10.3%) | 20 013 (10.3%) | 0.93 (0.77 to 1.13) | |
| Never | 3921 (47.5%) | 49 190 (25.3%) | 1.01 (0.91 to 1.11) | |
| Diabetes | ||||
| Yes | 3498 (42.4%) | 33 026 (16.9%) | 0.78 (0.71 to 0.86) | 1.00 |
| No | 4753 (57.6%) | 161 815 (83.1%) | 0.78 (0.70 to 0.87) | |
| Disease phenotype | ||||
| ACS type | ||||
| STEMI | 2974 (36.0%) | 69 918 (35.9%) | 1.04 (0.93 to 1.18) | <0.05 |
| NSTEMI | 4238 (51.4%) | 107 490 (55.2%) | 0.86 (0.79 to 0.95) | |
| Unstable angina | 1039 (12.6%) | 17 433 (9.0%) | 0.78 (0.58 to 1.05) | |
| Peak troponin (ng/ml) | ||||
| ≤0.05 | 700 (10.0%) | 12 288 (7.0%) | 0.72 (0.48 to 1.09) | 0.06 |
| >0.05 to ≤1 | 2605 (37.1%) | 64 869 (36.8%) | 0.84 (0.74 to 0.96) | |
| >1 | 3710 (52.9%) | 99 134 (56.2%) | 0.98 (0.88 to 1.08) | |
| Prognostic risk at admission | ||||
| Q1 low | 2502 (34.4%) | 33 984 (19.4%) | 0.67 (0.47 to 0.94) | |
| Q2 | 1723 (23.7%) | 34 763 (19.9%) | 1.35 (1.12 to 1.62) | |
| Q3 | 1537 (21.1%) | 34 949 (20.0%) | 0.95 (0.82 to 1.11) | |
| Q4 | 1012 (13.9%) | 35 474 (20.3%) | 0.90 (0.79 to 1.03) | <0.01 |
| Q5 high | 500 (6.9%) | 35 986 (20.6%) | 0.74 (0.64 to 0.86) | |
| Management | ||||
| Secondary prevention drugs | ||||
| 0 | 991 (9.96%) | 37 845 (15.5%) | 1.10 (0.99 to 1.23) | |
| 1 | 286 (2.9%) | 8472 (3.5%) | 0.72 (0.46 to 1.11) | |
| 2 | 732 (7.4%) | 22 966 (9.4%) | 0.81 (0.63 to 1.05) | |
| 3 | 2280 (22.9%) | 58 147 (23.9%) | 0.83 (0.70 to 0.99) | <0.05 |
| 4 | 5657 (56.9%) | 116 276 (47.7%) | 1.11 (0.97 to 1.28) | |
| Receipt/planned coronary angiography | ||||
| Yes | 4905 (66.2%) | 5569 (51.3%) | 1.32 (1.16 to 1.49) | <0.01 |
| No | 2506 (33.8%) | 81 318 (48.7%) | 0.85 (0.77 to 0.94) | |
| Revascularisation—PPCI | ||||
| Yes | 2380 (32.3%) | 33 301 (19.3%) | 1.50 (1.24 to 1.81) | <0.01 |
| No | 4998 (67.7%) | 138 928 (80.7%) | 0.88 (0.82 to 0.96) | |
HR (95% CI)—Cox proportional hazards regression ratio comparing South Asian and white participants for coronary death (all-cause in ACS cohort).
A hazard ratio less than 1 represents a better prognosis in South Asians.
Secondary prevention drugs: aspirin, statin, β-blocker and ACE inhibitor.
*Of the 4010 South Asians with individual component group data available post-2007.
†Ethnic density—in thirds: low 79 hospitals, medium 76 hospitals, high 76 hospitals.
ACS, acute coronary syndrome; NSTEMI, non-ST-elevation myocardial infarction; PPCI, primary percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.