Key result
Lower socioeconomic status was associated with longer median reperfusion times but was not an independent predictor of 12-month major adverse cardiovascular events.
Why the study?
Prior studies linking low SES to worse cardiovascular outcomes largely occurred in countries lacking universal healthcare, leaving its impact in settings like Australia unclear.
Does lower socioeconomic status impact 12-month major adverse cardiovascular events in STEMI patients undergoing PCI in a universal healthcare system?
Cohort (n=5,665)
Yes
Does lower socioeconomic status impact 12-month major adverse cardiovascular events in STEMI patients undergoing PCI in a universal healthcare system?
Answers are grounded in this paper and cite their sources.
In a universal healthcare system, socioeconomic status does not independently predict 12-month MACE in STEMI patients undergoing PCI, despite differences in baseline comorbidities and reperfusion times.
BACKGROUND: Low socioeconomic status (SES) has been previously shown to be associated with worse cardiovascular outcomes. However, unlike in Australia, many of these studies have been performed in countries without universal healthcare where SES may be expected to have a greater impact on care and outcomes. We sought to determine whether there is an association between SES and baseline characteristics, clinical outcomes and use of secondary prevention therapy in patients with ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: We prospectively collected data on 5665 consecutive ST-segment-elevation myocardial infarction PCI patients between 2005 and 2015 from 6 government-funded hospitals participating in a multicenter registry. Patients were categorized into SES quintiles using the Index of Relative Socioeconomic Disadvantage system, a score allocated to each residential postcode based on factors like income, educational level, and employment status by the Australian Bureau of Statistics. In our study, lower SES patients were more likely to have diabetes mellitus, smoke, and initially present to a non-PCI capable hospital (all P≤0.01). Among primary PCI patients, the median time to reperfusion was slightly higher in lower SES groups (211 [144-337] versus 193 [145-285] minutes, P<0.001). Drug-eluting stent use was higher in the higher SES groups ( P<0.001). At 12 months after PCI, lower SES patients had higher rates of ongoing smoking and lower use of guideline-recommended secondary prevention therapy (both P<0.01). Despite these differences, SES group was not found to be an independent predictor of 12-month major adverse cardiovascular events. CONCLUSIONS: Lower SES patients have more comorbidities and experienced slightly longer reperfusion times but otherwise similar care. Despite these baseline differences, clinical outcomes after ST-segment-elevation myocardial infarction PCI were similar regardless of SES.
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Biswas et al. (2019) conducted a cohort in ST-segment-elevation myocardial infarction (n=5,665). Low socioeconomic status vs. Higher socioeconomic status was evaluated on 12-month major adverse cardiovascular events. Lower socioeconomic status was associated with longer median reperfusion times but was not an independent predictor of 12-month major adverse cardiovascular events.
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