Document Detail


Dimensions of Socioeconomic Status and Clinical Outcome After Primary Percutaneous Coronary Intervention.
MedLine Citation:
PMID:  23031837     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: THE ASSOCIATION BETWEEN LOW SOCIOECONOMIC STATUS (SES) AND HIGH MORTALITY FROM CORONARY HEART DISEASE IS WELL-KNOWN. HOWEVER, THE ROLE OF SES IN RELATION TO THE CLINICAL OUTCOME AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION REMAINS POORLY UNDERSTOOD.METHODS AND RESULTS: WE STUDIED 7385 PATIENTS TREATED WITH PRIMARY PERCUTANEOUS CORONARY INTERVENTION. PARTICIPANTS WERE DIVIDED INTO HIGH-SES AND LOW-SES GROUPS ACCORDING TO INCOME, EDUCATION, AND EMPLOYMENT STATUS. THE PRIMARY OUTCOME WAS MAJOR ADVERSE CARDIAC EVENTS (CARDIAC DEATH, RECURRENT MYOCARDIAL INFARCTION, AND TARGET VESSEL REVASCULARIZATION) AT MAXIMUM FOLLOW-UP (MEAN, 3.7 YEARS). LOW-SES PATIENTS HAD MORE ADVERSE BASELINE RISK PROFILES THAN HIGH-SES PATIENTS. THE CUMULATIVE RISK OF MAJOR ADVERSE CARDIAC EVENTS AFTER MAXIMUM FOLLOW-UP WAS HIGHER AMONG LOW-INCOME PATIENTS AND UNEMPLOYED PATIENTS COMPARED WITH THEIR COUNTERPARTS (INCOME: HAZARD RATIO, 1.68; 95% CI, 1.471.92; EMPLOYMENT STATUS: HAZARD RATIO, 1.75; 95% CI, 1.462.10). AFTER ADJUSTMENT FOR PATIENT CHARACTERISTICS, THESE DIFFERENCES WERE SUBSTANTIALLY ATTENUATED (INCOME: HAZARD RATIO, 1.12; 95% CI, 0.931.33; EMPLOYMENT STATUS: HAZARD RATIO, 1.27; 95% CI, 1.031.56). FURTHER ADJUSTMENT FOR ADMISSION FINDINGS, PROCEDURE-RELATED DATA, AND MEDICAL TREATMENT DURING FOLLOW-UP DID NOT SIGNIFICANTLY AFFECT THE ASSOCIATIONS. WITH EDUCATION AS THE SES INDICATOR, NO BETWEEN-GROUP DIFFERENCES WERE OBSERVED IN THE RISK OF THE COMPOSITE END POINT.CONCLUSIONS: Even in a tax-financed healthcare system, low-SES patients treated with primary percutaneous coronary intervention face a worse prognosis than high-SES patients. The poor outcome seems to be largely explained by differences in baseline patient characteristics. Employment status and income (but not education level) were associated with clinical outcomes.
Authors:
Lars Jakobsen; Troels Niemann; Niels Thorsgaard; Leif Thuesen; Jens F Lassen; Lisette O Jensen; Per Thayssen; Jan Ravkilde; Hans H Tilsted; Frank Mehnert; Søren P Johnsen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-2
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
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