• Vol. 48 No. 3
  • 15 March 2019

Ethnic Differences and Trends in ST-Segment Elevation Myocardial Infarction Incidence and Mortality in a Multi-Ethnic Population

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ABSTRACT

This study aimed to compare the incidence and mortality of ST-segment elevation myocardial infarction (STEMI) across the 3 main ethnic groups in Singapore, determine if there is any improvement in trends over the years and postulate the reasons underlying the ethnic disparity. Materials and Methods: This study consisted of 16,983 consecutive STEMI patients who sought treatment from all public hospitals in Singapore from 2007 to 2014. Results: Compared to the Chinese (58 per 100,000 population in 2014), higher STEMI incidence rate was consistently observed in the Malays (114 per 100,000 population) and Indians (126 per 100,000 population). While the incidence rate for the Chinese and Indians remained relatively stable over the years, the incidence rate for the Malays rose slightly. Relative to the Indians (30-day and 1-year all-cause mortality at 9% and 13%, respectively, in 2014), higher 30-day and 1-year all-cause mortality rates were observed in the Chinese (15% and 21%) and Malays (13% and 18%). Besides the Malays having higher adjusted 1-year all-cause mortality, all other ethnic disparities in 30-day and 1-year mortality risk were attenuated after adjusting for demographics, comorbidities and primary percutaneous coronary intervention. Conclusion: It is important to continuously evaluate the effectiveness of existing programmes and practices as the aetiology of STEMI evolves with time, and to strike a balance between prevention and management efforts as well as between improving the outcome of “poorer” and “better” STEMI survivors with finite resources.


Ischaemic heart disease (IHD) is the world’s leading cause
of death and is responsible for more than 8 million deaths
each year.1 Mirroring global trends, IHD has been among
the top 3 causes of death for Singapore residents in recent
years.2 With Singapore’s ageing population, coupled with
the high prevalence of cardiovascular (CV) risk factors
in the community,3 the incidence and mortality of acute
myocardial infarction (AMI) are expected to rise in future.
Hence, it is imperative to identify at-risk subpopulations
so that targeted prevention and management programmes
can be implemented to improve outcomes.

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