| Dimensions of Socioeconomic Status and Clinical Outcome After Primary Percutaneous Coronary Intervention. | |
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MedLine Citation:
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PMID: 23031837 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: JOURNAL ARTICLE Date: 2012-10-2 |
Journal Detail:
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Title: Circulation. Cardiovascular interventions Volume: - ISSN: 1941-7632 ISO Abbreviation: Circ Cardiovasc Interv Publication Date: 2012 Oct |
Date Detail:
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Created Date: 2012-10-3 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101499602 Medline TA: Circ Cardiovasc Interv Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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