Differences in late cardiovascular mortality following acute myocardial infarction in three major Asian ethnic groups

Leonardo P. de Carvalho, Fei Gao, Qifeng Chen, Mikael Hartman, Ling Ling Sim, Tian Hai Koh, David Foo, Chee Tang Chin, Hean Yee Ong, Khim Leng Tong, Huay Cheem Tan, Tiong Cheng Yeo, Chow Khuan Yew, Arthur M. Richards, Eric D. Peterson, Terrance Chua, Mark Y. Chan

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


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. 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). 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.

Original languageEnglish (US)
Pages (from-to)354-362
Number of pages9
JournalEuropean Heart Journal: Acute Cardiovascular Care
Issue number4
StatePublished - Dec 2014
Externally publishedYes


  • Epidemiology
  • ethnic differences
  • outcome

ASJC Scopus subject areas

  • Medicine(all)


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