Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study

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Abstract
Objective: To compare mortality in south Asian (Indian, Pakistani, and Bangladeshi) and white patients in the six months after hospital admission for acute myocardial infarction. Design: Observational study. Setting: District general hospital in east London. Patients: 149 south Asian and 313 white patients aged Main outcome measure: All cause mortality in the first six months after myocardial infarction. Results: The admission rate in the south Asians was estimated to be 2.04 times that in the white patients. Most aspects of treatment were similar in the two groups, except that a higher proportion of the south Asians received thrombolytic drugs (81.2% v 73.8%). After adjustment for age, sex, previous myocardial infarction, and treatment with thrombolysis or aspirin, or both, the south Asians had a poorer survival over the six months from myocardial infarction (hazard ratio 2.02 (95% confidence interval 1.14 to 3.56), P=0.018), but a substantially higher proportion were diabetic (38% v 11%, PConclusion: South Asian patients had a higher risk of admission with myocardial infarction and a higher risk of death over the ensuing six months than the white patients. The higher case fatality among the south Asians, largely attributable to diabetes, may contribute to the increased risk of death from coronary heart disease in south Asians living in Britain. This study shows that south Asians have high mortality in the first six months after a heart attack This may contribute to the high standardised mortality ratios for coronary disease in south Asians living in the Britain Diabetes may be an important contributor to this excess risk The high prevalence of diabetes and relatively poor prognosis after myocardial infarction in south Asian patients are important to consider in clinical management