{"id":"46006","type":"article","url":"https://hartvaat.nl/2026/04/30/etnische-verschillen-in-sterfte-na-acuut-coronair-syndroom-hogere-mortaliteit-bi/","title":"Etnische verschillen in sterfte na acuut coronair syndroom: hogere mortaliteit bij zwarte STEMI-patiënten","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e004072?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e004072?rss=1","authors":["Mayet","Y.","Wasan","D.","Sesia","D.","Shah","A. S. V.","Johnson","T.","Kaura","A."],"significance":7,"published":"2026-07-11","source_date":"2026-04-30","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/coronairlijden/ecg-bij-acs/"],"congress":"","summary_en":"Systematic review and meta-analysis of 40 cohort and registry studies (total 14 million patients from the USA, UK, and Canada) on ethnic disparities in mortality after acute coronary syndrome (ACS). Overall mortality was similar between Black and White patients (RR 0.99; 95% CI 0.94-1.03) and between Asian and White patients (RR 1.06; 95% CI 0.95-1.17); however, in US-based studies, Asian patients had higher mortality (RR 1.14; 95% CI 1.03-1.27). Subgroup analysis showed significantly higher mortality in Black patients after STEMI (RR 1.09; 95% CI 1.02-1.17). Meta-regression demonstrated an age-modifying effect for Black-versus-White comparisons: differences attenuated in older populations. Pooled risk of major bleeding was comparable between groups. The findings suggest ethnic disparities in ACS outcomes persist in specific contexts and may be more pronounced in younger patients — though interpretation requires caution due to heterogeneity.","created":"2026-07-03T20:27:04Z","updated":"2026-07-04T19:09:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse van 40 cohort- en registerstudies (totaal 14 miljoen patiënten uit VS, VK en Canada) over etnische verschillen in mortaliteit na acuut coronair syndroom (ACS). Algemene mortaliteit was vergelijkbaar tussen zwarte en witte patiënten (RR 0,99; 95%-BI 0,94-1,03) en tussen Aziatische en witte patiënten (RR 1,06; 95%-BI 0,95-1,17); echter, in Amerikaanse studies hadden Aziatische patiënten hogere mortaliteit (RR 1,14; 95%-BI 1,03-1,27). In subgroep-analyse hadden zwarte patiënten significant hogere sterfte na STEMI (RR 1,09; 95%-BI 1,02-1,17). Meta-regressie toonde een leeftijds-modificerend effect bij zwart-versus-wit-vergelijkingen: het verschil verzwakte in oudere populaties. Gepoold risico op grote bloedingen was vergelijkbaar tussen groepen. De resultaten suggereren dat etnische ongelijkheid in ACS-uitkomsten in specifieke contexten blijft bestaan en mogelijk sterker is bij jongere patiënten — interpretatie wel met voorbehoud vanwege heterogeniteit.","abstract_original":"<sec><st>Objective</st>\n<p>To quantify ethnic disparities in mortality after acute coronary syndrome (ACS) by comparing outcomes in Black, Asian and hite population groups.</p>\n</sec>\n<sec><st>Methods</st>\n<p>We conducted a systematic review and meta-analysis of observational studies reporting mortality after ACS by ethnicity. Embase, Global Health, Ovid MEDLINE and Web of Science were searched through to March 2026 for English-language studies of adults with ST-elevation myocardial infarction (STEMI), non-STEMI or unstable angina. Two reviewers independently screened records, extracted data and assessed risk of bias using the Newcastle-Ottawa Scale. The primary outcome was all-cause mortality. Risk ratios (RRs), ORs and HRs were pooled as relative risk (RRs) with 95% CIs using random-effects models. Heterogeneity was quantified with I&sup2; and explored using prespecified subgroup analyses and meta-regression.</p>\n</sec>\n<sec><st>Results</st>\n<p>Forty cohort and registry studies from the USA, UK and Canada including 14 million patients met the inclusion criteria. Overall mortality was similar in black versus white patients (RR 0.99, 95% CI 0.94 to 1.03) and Asian versus white patients (RR 1.06, 95% CI 0.95 to 1.17); however, restriction to US-based studies demonstrated higher mortality in Asian patients (RR 1.14, 95% CI 1.03 to 1.27). Subgroup analyses showed higher mortality in black patients following STEMI (RR 1.09, 95% CI 1.02 to 1.17). Meta-regression showed age-dependent effect modification in black versus white comparisons, with differences attenuating in older populations. The pooled risk of major bleeding was similar between groups.</p>\n</sec>\n<sec><st>Conclusions</st>\n<p>Black patients had higher mortality than white patients following STEMI, and Asian patients demonstrated higher mortality in US-based studies. Overall post-ACS mortality was otherwise similar across ethnic groups. These findings suggest disparities persist in specific contexts and may be more pronounced in younger populations, but should be interpreted with caution due to substantial heterogeneity.</p>\n</sec>\n<sec><st>PROSPERO registration number</st>\n<p><A HREF=\"https://www.crd.york.ac.uk/PROSPERO/view/CRD420250465260\">https://www.crd.york.ac.uk/PROSPERO/view/CRD420250465260</A></p>\n</sec>"}