ST-Elevation Myocardial Infarction in a Migrant Population: a Registry Based Study of Patient Treatment and Outcomes.

BACKGROUND: Internationally a growing number of studies have identified race related disparities in the presentation, treatment and outcomes of patients with ST-Elevation Myocardial Infarction (STEMI). With a large migrant population Australia presents a unique microcosm in which to study the impact of migrant status and ethnicity in STEMI patients.

AIM & METHODS: We conducted a retrospective observational study utilising data from a clinician-initiated registry to investigate if first-generation migrants differed in presentation, treatment or outcomes following STEMI compared with the Australian-born population. The study involved 2,154 patients who presented to 12 hospitals between 2004-2012. Our main outcome measures included time to reperfusion, 30-day mortality and complications.

RESULTS: Migrants (n=1035, 48.8%) were more likely to be older (61 vs 58yr, p<0.001), diabetic (29.3 vs. 21.5%, p<0.001) and have a prolonged symptom to door time (102 vs 91min, p=0.04). Despite lower rates of previous known ischaemic heart disease (22.5 vs 26.6%, p=0.03) migrants had more diffuse disease (triple vessel or left main (3VD/LM): 29.8 vs. 22.0%, p<0.001) and higher troponin values (3.77 vs 3.22μg/L, p=0.01). We found no significant differences in hospital treatment times, intervention types or rates. Multivariate regression identified age, diabetes, female gender and multi-vessel disease as predictors of complications and death at 30 days.

CONCLUSIONS: Migrants had longer pre-hospital delays and exhibited different cardiovascular risk profiles to Australian-born patients but received comparable treatment in the acute hospital setting. Higher rates of diabetes and multi-vessel coronary artery disease were seen amongst migrant patients indicating a relatively higher risk population. This article is protected by copyright. All rights reserved.