Acute Coronary Syndrome and Long-term Survival in South Asians: Insights from the UK ACALM Registry

Background
Acute Coronary Syndromes (ACS) are associated with significant morbidity and mortality. However, the impact of race has not been fully explored. We evaluated the frequency, clinical characteristics, and long-term survival in South Asian and Caucasian White patients with ACS using a ‘big data’ approach.

Methods
Using the United Kingdom (UK) Algorithm for Co-morbidity, Associations, Length of stay, and Mortality (ACALM) registry, we analyzed 1,816,230 adults hospitalized between January 2000 and July 2014 using ICD-10 and OPCS-4 coding systems. Ethnic status was identified and ACS patients were selected. Using logistic regression, we examined the differences between the groups and used cox-regression model to evaluate mortality and in both cases adjusting for demographics and co-morbid status.

Results
In our large cohort, South Asian patients had a lower frequency of ACS hospitalization compared with Caucasian White patients (1.2% [2992/243,363] versus 2.1% [24314/ 1, 151, 222], p=<0.001). Differences in demographics and baseline characteristics are highlighted in the Table. Following adjustment, South Asian ethnicity was associated with a higher long-term mortality compared with Caucasian White with ACS (HR 1.67, 95% CI 1.53-1.82, p<0.001).

Conclusions
In a ‘big data’ UK registry, South Asians with ACS are significantly younger at presentation, have more cardiovascular risk factors and have worse long term survival compared with Caucasian White patients. Further investigation is required to understand the impact of race on ACS prevalence and outcomes.