Mazengarb Janine, Grey Corina, Lee Mildred, Poppe Katrina, Mehta Suneela, Harwood Matire, Harrison Wil, Earle Nicki, Jackson Rod, Kerr Andrew
Cardiology Trainee, Counties Manukau District Health Board.
Public Health Physician, Auckland District Health Board.
N Z Med J. 2020 Sep 4;133(1521):40-54.
Ischaemic heart disease (IHD) mortality rates after myocardial infarction (MI) are higher in Māori and Pacific compared to European people. The reasons for these differences are complex and incompletely understood. Our aim was to use a contemporary real-world national cohort of patients presenting with their first MI to better understand the extent to which differences in the clinical presentation, cardiovascular (CVD) risk factors, comorbidity and in-hospital treatment explain the mortality outcomes for Māori and Pacific peoples.
New Zealand residents (≥20 years old) hospitalised with their first MI (2014-2017), and who underwent coronary angiography, were identified from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. All-cause mortality up to one year after the index admission date was obtained by linkage to the national mortality database.
There were 17,404 patients with a first ever MI. European/other comprised 76% of the population, Māori 11.5%, Pacific 5.1%, Indian 4.3% and Other Asian 2.9%. Over half (55%) of Māori, Pacific and Indian patients were admitted with their first MI before age 60 years, compared with 29% of European/other patients. Māori and Pacific patients had a higher burden of traditional and non-traditional cardiovascular risk factors, and despite being younger, were more likely to present with heart failure and, together with Indian peoples, advanced coronary disease at presentation with first MI. After adjustment for age and sex, Māori and Pacific, but not Indian or Other Asian patients had significantly higher all-cause mortality at one year compared with the European/other reference group (HR 2.55 (95% CI 2.12-3.07), HR 2.98 (95% CI 2.34-3.81) for Māori and Pacific respectively). When further adjusted for differences in clinical presentation, clinical history and cardiovascular risk factors, the excess mortality risk for Māori and Pacific patients was reduced substantially, but a differential persisted (HR 1.77 (95% CI 1.44-2.19), HR 1.42 (95% CI 1.07-1.83)) which was not further reduced by adjustment for differences in in-hospital management and discharge medications.
In New Zealand patients after their first MI there is a three-fold variation in one-year mortality based on ethnicity. At least half of the inequity in outcomes for Māori, and three-quarters for Pacific people, is associated with differences in preventable or modifiable clinical factors present at, or prior to, presentation.
与欧洲人相比，毛利人和太平洋岛民心肌梗死（MI）后缺血性心脏病（IHD）死亡率更高。这些差异的原因复杂且尚未完全明了。我们的目的是利用一个当代现实世界中首次发生MI的全国患者队列，以更好地了解临床表现、心血管（CVD）危险因素、合并症及住院治疗方面的差异在多大程度上解释了毛利人和太平洋岛民的死亡结局。
从全新西兰急性冠状动脉综合征质量改进（ANZACS-QI）登记处识别出因首次MI住院（2014 - 2017年）且接受了冠状动脉造影的新西兰居民（≥20岁）。通过与国家死亡率数据库关联获取首次入院日期后一年内的全因死亡率。
共有17404例首次发生MI的患者。欧洲/其他族裔占人口的76%，毛利人占11.5%，太平洋岛民占5.1%，印度人占4.3%，其他亚洲人占2.9%。超过一半（55%）的毛利、太平洋岛民和印度患者在60岁之前首次发生MI入院，而欧洲/其他族裔患者这一比例为29%。毛利人和太平洋岛民患者传统和非传统心血管危险因素负担更高，尽管更年轻，但更易出现心力衰竭，并且与印度人一样，首次发生MI时更易出现晚期冠状动脉疾病。在调整年龄和性别后，与欧洲/其他族裔参考组相比，毛利人和太平洋岛民患者在一年时全因死亡率显著更高（毛利人的风险比（HR）为2.55（95%置信区间（CI）2.12 - 3.07），太平洋岛民的HR为2.98（95% CI 2.34 - 3.81））。当进一步调整临床表现、临床病史和心血管危险因素的差异后，毛利人和太平洋岛民患者的额外死亡风险大幅降低，但差异仍然存在（HR 1.77（95% CI 1.44 - 2.19），HR 1.42（95% CI 1.07 - 1.83）），通过调整住院管理和出院用药差异并未进一步降低。
在新西兰首次发生MI后的患者中，基于种族的一年死亡率存在三倍差异。毛利人至少一半的结局不平等以及太平洋岛民四分之三的结局不平等与就诊时或就诊前存在的可预防或可改变的临床因素差异有关。
