de Hoog Vince C, Lim Swee Han, Bank Ingrid Em, Gijsberts Crystel M, Ibrahim Irwani B, Kuan Win Sen, Ooi Shirley Bs, Chua Terrance, den Ruijter Hester M, Pasterkamp Gerard, Tai E Shyong, Gao Fei, Doevendans Pieter A, Wildbergh Thierry X, Mosterd Arend, Richards A Mark, de Kleijn Dominique Pv, Timmers Leo
1 Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands.
2 ICIN - Netherlands Heart Institute, The Netherlands.
Eur Heart J Acute Cardiovasc Care. 2016 Nov;5(7):32-40. doi: 10.1177/2048872615623064. Epub 2016 Sep 22.
Ethnicity, although known to influence cardiovascular outcome in assorted clinical settings, has not been investigated previously as a risk factor in patients presenting to the emergency department with suspected acute myocardial infarction.
In this multi-ethnic cohort study conducted in Singapore and The Netherlands, 2784 patients presenting to the emergency department with chest pain were enrolled (788 Caucasians, 1281 Chinese, 404 Indians and 311 Malays) and were followed up for 1 year.
Although Caucasian patients on average were older and had incurred more cardiovascular adverse events, the Asian ethnic groups carried a greater burden of cardiovascular risk factors. Caucasian and Malay patients were most frequently diagnosed with acute myocardial infarction (Caucasians 11.2%, Chinese and Indians 6.4%, Malays 10.6%, P<0.001), also after correction for baseline differences. Chinese and Indian patients, however, more often had unstable angina. Asian patients had strikingly more extensive coronary artery disease than Caucasian patients (triple-vessel disease: Caucasians 6.5%, Chinese 22.8%, Indians 32.4%, Malays 32.8%, P<0.001) and Chinese patients with myocardial infarction more frequently underwent coronary revascularisation compared with Caucasian patients (Caucasians 41.4%, Chinese 67.5%, Indians 62.5%, Malay 46.7%, P=0.005). Ethnicity was not an independent predictor of major adverse cardiovascular events during 1-year follow-up in all chest pain patients.
The prevalence of myocardial infarction and unstable angina, revascularisation rate and extent of coronary artery disease differ significantly among chest pain patients of different ethnic groups. These findings have important clinical implications and support consideration of ethnicity in risk stratification and determination of the patient management strategy in patients with symptoms suggestive of myocardial infarction.
尽管已知种族在各种临床环境中会影响心血管结局，但此前尚未将其作为疑似急性心肌梗死而就诊于急诊科的患者的危险因素进行研究。
在新加坡和荷兰进行的这项多民族队列研究中，纳入了2784例因胸痛就诊于急诊科的患者（788例白种人、1281例中国人、404例印度人和311例马来人），并对其进行了1年的随访。
尽管白种人患者平均年龄较大且发生了更多的心血管不良事件，但亚洲种族群体的心血管危险因素负担更重。白种人和马来人患者最常被诊断为急性心肌梗死（白种人11.2%，中国人和印度人6.4%，马来人10.6%，P<0.001），在校正基线差异后也是如此。然而，中国人和印度人患者更常发生不稳定型心绞痛。亚洲患者的冠状动脉疾病比白种人患者明显更广泛（三支血管病变：白种人6.5%，中国人22.8%，印度人32.4%，马来人32.8%，P<0.001），与白种人患者相比，发生心肌梗死的中国患者更频繁地接受冠状动脉血运重建（白种人41.4%，中国人67.5%，印度人62.5%，马来人46.7%，P=0.005）。在所有胸痛患者的1年随访期间，种族不是主要不良心血管事件的独立预测因素。
不同种族的胸痛患者中心肌梗死和不稳定型心绞痛的患病率、血运重建率和冠状动脉疾病的程度存在显著差异。这些发现具有重要的临床意义，并支持在对疑似心肌梗死症状的患者进行风险分层和确定患者管理策略时考虑种族因素。
