Key result
Very low socioeconomic status increased the 5-year risk of major adverse cardiac and cerebrovascular events post-MI compared to high socioeconomic status (HR 2.31; 95% CI 1.31-4.09; p=0.004).
Why the study?
The independent impact of socioeconomic status on cardiovascular risk and long-term prognosis after myocardial infarction remains underexplored in the context of contemporary medical advancements.
Does lower socioeconomic status increase the risk of long-term MACCE in patients after myocardial infarction?
Cohort (n=2,807)
No
Does lower socioeconomic status increase the risk of long-term MACCE in patients after myocardial infarction?
Effect estimate: HR 2.31 (95% CI 1.31-4.09)
p-value: p=0.004
Lower socioeconomic status in patients with myocardial infarction is associated with earlier disease onset, higher prevalence of risk factors, and an approximately twofold higher risk of long-term MACCE.
Background Socioeconomic status (SES) is a known determinant of cardiovascular outcomes, yet its independent impact on cardiovascular risk and long-term prognosis in patients after myocardial infarction (MI) remains underexplored in the context of contemporary medical advancements. Methods All consecutive patients admitted with MI to our heart center between 2015 and 2022 were included. Patients were stratified into four SES groups (G1: high, G2: intermediate, G3: low, G4: very low). Long-term major adverse cardiac and cerebrovascular events (MACCE) over a 5-year period were analyzed by SES group in multivariable analyses, adjusted for age, sex, traditional risk factors, interventional success, and infarction severity. Results A total of 2,807 patients were included (mean age: 65.4 ± 13.2 years). Lower SES was associated with younger age at first MI (G1: 67.7 ± 13.2 years; G4: 61.8 ± 12.4 years; p < 0.01). Multivariable analysis confirmed this association, with decreasing SES linked to progressively younger MI onset. Patients in lower SES groups exhibited higher body mass index (G1: 26.7 ± 4.8 kg/m²; G4: 29.0 ± 6.0 kg/m²; p < 0.01), smoking rates (G1: 33.0%; G4: 54.4%; p < 0.01), and diabetes prevalence (G1: 19.9%; G4: 31.9%; p < 0.01). Killip classification, ejection fraction, the number of diseased coronary arteries, and in-hospital outcomes, including mortality, showed no significant differences across SES groups (all p > 0.3). However, multivariable survival analysis demonstrated that long-term MACCE risk over a 5-year period was significantly higher in low SES patients (HR: 1.97; 95% CI: 1.27–3.05; p = 0.002) and very low SES patients (HR: 2.31; 95% CI: 1.31–4.09; p = 0.004) compared to high SES patients (figure 1). Conclusion Lower SES was associated with earlier MI onset, higher prevalence of lifestyle-related risk factors such as obesity, smoking, and diabetes. Although in-hospital outcomes did not significantly differ, long-term prognosis was independently worsened by lower SES. These findings emphasize the urgent need for targeted public health interventions to address socioeconomic disparities and improve long-term cardiovascular outcomes.
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Kerniss et al. (2025) conducted a cohort in Myocardial infarction (n=2,807). Very low socioeconomic status vs. High socioeconomic status was evaluated on Long-term major adverse cardiac and cerebrovascular events (MACCE) (HR 2.31, 95% CI 1.31-4.09, p=0.004). Very low socioeconomic status increased the 5-year risk of major adverse cardiac and cerebrovascular events post-MI compared to high socioeconomic status (HR 2.31; 95% CI 1.31-4.09; p=0.004).
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