Document Detail

First myocardial infarction in patients of Indian subcontinent and European origin: comparison of risk factors, management, and long term outcome.
MedLine Citation:
PMID:  9066475     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare long term outcome after first myocardial infarction among British patients originating from the Indian subcontinent and from Europe. DESIGN: Matched pairs study. SETTING: Coronary care unit in central Leicester. SUBJECTS: 238 pairs of patients admitted during 1987-93 matched for age (within 2 years), sex, date of admission (within 3 months), type of infarction (Q/non-Q), and site of infarction. MAIN OUTCOME MEASURES: Incidence of angina, reinfarction, or death during follow up of 1-7 years. RESULTS: Patients of Indian subcontinent origin had a higher prevalence of diabetes (35% v 9% in patients of European origin, P < 0.001), lower prevalence of smoking (39% v 63%, P < 0.001), longer median delay from symptom onset to admission (5 hours v 3 hours, P < 0.01), and lower use of thrombolysis (50% v 66%, P < 0.001). During long term follow up (median 39 months), mortality was higher in patients of Indian subcontinent origin (unadjusted hazard ratio = 2.1, 95% confidence interval 1.3 to 3.4, P = 0.002). After adjustment for smoking, history of diabetes, and thrombolysis the estimated hazard ratio fell slightly to 2.0 (1.1 to 3.6, P = 0.02). Patients of Indian subcontinent origin had almost twice the incidence of angina (54% v 29%; P < 0.001) and almost three times the risk of reinfarction during follow up (34% v 12.5% at 3 years, P < 0.001). The unadjusted hazard ratio for reinfarction in patients of Indian subcontinent origin was 2.8 (1.8 to 4.4, P < 0.001). Adjustment for smoking, history of diabetes, and thrombolysis made little difference to the hazard ratio. Coronary angiography was performed with similar frequency in the two groups; triple vessel disease was the commonest finding in patients of Indian subcontinent origin and single vessel disease the commonest in Europeans (P < 0.001). CONCLUSIONS: Patients of Indian subcontinent origin are at substantially higher risk of mortality and of further coronary events than Europeans after first myocardial infarction. This is probably due to their higher prevalence of diffuse coronary atheroma. Their need for investigation with a view to coronary revascularisation is therefore greater. History of diabetes is an inadequate surrogate for ethnic origin as a prognostic indicator.
N Shaukat; J Lear; A Lowy; S Fletcher; D P de Bono; K L Woods
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Retracted Publication    
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  314     ISSN:  0959-8138     ISO Abbreviation:  BMJ     Publication Date:  1997 Mar 
Date Detail:
Created Date:  1997-04-08     Completed Date:  1997-04-08     Revised Date:  2008-11-20    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  639-42     Citation Subset:  AIM; IM    
Department of Medicine and Therapeutics and Public Health, University of Leicester.
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MeSH Terms
Coronary Angiography
Diabetes Mellitus / ethnology
England / epidemiology
Europe / ethnology
Follow-Up Studies
India / ethnology
Matched-Pair Analysis
Myocardial Infarction / ethnology*,  mortality,  therapy
Myocardial Revascularization
Risk Factors
Comment In:
BMJ. 1997 Jul 12;315(7100):119; author reply 119-20   [PMID:  9240059 ]
BMJ. 1997 Jul 12;315(7100):119; author reply 119-20   [PMID:  9240058 ]
BMJ. 1997 Jul 12;315(7100):118; author reply 119-20   [PMID:  9240056 ]
BMJ. 1997 Jul 12;315(7100):118-9   [PMID:  9240057 ]
BMJ. 2002 Sep 7;325(7363):509   [PMID:  12217981 ]
Retraction In:
Shaukat N, Lear J, Lowy A, Fletcher S, de Bono DP, Woods KL. BMJ. 1998 Jan 10;316(7125):116   [PMID:  9490125 ]

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