Abstract
Objective
To quantify ethnic disparities in mortality after acute coronary syndrome (ACS) by comparing outcomes in Black, Asian and hite population groups.
Methods
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 I² and explored using prespecified subgroup analyses and meta-regression.
Results
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.
Conclusions
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.
PROSPERO registration number https://www.crd.york.ac.uk/PROSPERO/view/CRD420250465260
To quantify ethnic disparities in mortality after acute coronary syndrome (ACS) by comparing outcomes in Black, Asian and hite population groups.
Methods
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 I² and explored using prespecified subgroup analyses and meta-regression.
Results
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.
Conclusions
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.
PROSPERO registration number https://www.crd.york.ac.uk/PROSPERO/view/CRD420250465260
| Original language | English |
|---|---|
| Article number | e004072 |
| Number of pages | 9 |
| Journal | Open Heart |
| Volume | 13 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 30 Apr 2026 |
Bibliographical note
Publisher Copyright:© Author(s) (or their employer(s)) 2026.
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