Being in the most deprived socioeconomic quintile was associated with a higher risk of long-term all-cause mortality after PCI compared to the least deprived quintile (HR 1.15; 95% CI 1.10-1.42).
Cohort (n=123,780)
Yes
Does lower socioeconomic status increase long-term all-cause mortality in patients undergoing PCI?
Lower socioeconomic status is an independent predictor of increased long-term all-cause mortality following percutaneous coronary intervention.
Effect estimate: HR 1.15 (95% CI 1.10-1.42)
p-value: p=0.0044
BACKGROUND: Lower socioeconomic status (SES) has been associated with increased mortality from coronary heart disease. This excess risk, relative to affluent patients, may be due to a combination of more adverse cardiovascular-risk factors, inequalities in access to cardiac investigations, longer waiting times for cardiac revascularisation and lower use of secondary prevention drugs. We sought to investigate whether socio-economic status influenced long-term all-cause mortality after PCI in a large metropolitan city (London), which serves a population of 11 million people with a mixed social background over a 10-year period. METHODS: We conducted an observational cohort study of 123,780 consecutive PCI procedures from the Pan-London (United Kingdom) PCI registry. This data set is collected prospectively and includes all patients treated between January 2005 and December 2015. The database includes PCI performed for stable angina and ACS (ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina). Patient socio-economic status was defined by the English Index of Multiple Deprivation (IMD) score, according to residential postcode. Patients were analysed by quintile of IMD score (Q1, least deprived; Q5, most deprived). Median follow-up was 3.7 (IQR: 2.0-5.1) years and the primary outcome was all-cause mortality. RESULTS: = 0.0044). This persisted following the inclusion of a propensity score in the proportional hazard model as a covariate (HR for Q5 compared to Q1: 1.15 95% CI: 1.10-1.42). CONCLUSIONS: This study has demonstrated that low SES is an independent predictor of adverse clinical outcomes following PCI in the large, diverse metropolitan city of London. There clearly are inequalities in cardio-vascular risk factors, time to access to medical treatment/PCI, access to complex imaging and devices during PCI, access to secondary prevention after PCI, and even race differences. Hence, attention to reducing the burden of cardiovascular risk factors and improving primary prevention, particularly in patients with lower SES, is required.
Rathod et al. (Mon,) conducted a cohort in Stable angina and acute coronary syndrome requiring PCI (n=123,780). Most deprived socioeconomic status (Quintile 5) vs. Least deprived socioeconomic status (Quintile 1) was evaluated on All-cause mortality (HR 1.15, 95% CI 1.10-1.42, p=0.0044). Being in the most deprived socioeconomic quintile was associated with a higher risk of long-term all-cause mortality after PCI compared to the least deprived quintile (HR 1.15; 95% CI 1.10-1.42).