Dimensions of Socioeconomic Status and Clinical Outcome After Primary Percutaneous Coronary Intervention
Dimensions of Socioeconomic Status and Clinical Outcome After Primary Percutaneous Coronary Intervention
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DOI：
10.1161/circinterventions.112.968271
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发表时间：
2012-10-01
影响因子：
5.6
通讯作者：
Johnsen, Soren P.
中科院分区：
文献类型：
--
作者：
Jakobsen, Lars;Niemann, Troels;Johnsen, Soren P.
低社会经济地位（SES）和冠心病高死亡率之间的关系是众所周知的。然而，SES的作用与直接经皮冠状动脉介入治疗后的临床结果仍然知之甚少。方法和结果，我们研究了7385例直接经皮冠状动脉介入治疗的患者。参与者根据收入、教育和就业状况分为高SES组和低SES组。主要结局是最长随访期（平均3.7年）的主要不良心脏事件（心源性死亡、复发性心肌梗死和靶血管血运重建）。低SES患者比高SES患者有更多的不良基线风险特征。低收入患者和失业患者在最长随访期后发生主要不良心脏事件的累积风险高于其对应人群（收入：风险比，1.68; 95%CI，1.47-1.92;就业状况：风险比，1.75; 95%CI，1.46-2.10）。调整患者特征后，这些差异显著减弱（收入：风险比，1.12; 95% CI，0.93-1.33;就业状况：风险比，1.27; 95% CI，1.03-1.56）。进一步调整入院结果、手术相关数据和随访期间的药物治疗对相关性没有显著影响。教育作为SES指标，没有观察到组间差异的风险的复合endpoint. Conclusions，即使在税收资助的医疗保健系统，低SES患者接受直接经皮冠状动脉介入治疗面临的预后差于高SES患者。不良结局似乎在很大程度上可以由基线患者特征的差异来解释。就业状况和收入（而不是教育水平）与临床结果相关。(Circ血管介入2012;5：641-648）。
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, 1.47-1.92; employment status: hazard ratio, 1.75; 95% CI, 1.46-2.10). After adjustment for patient characteristics, these differences were substantially attenuated (income: hazard ratio, 1.12; 95% CI, 0.93-1.33; employment status: hazard ratio, 1.27; 95% CI, 1.03-1.56). 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. (Circ Cardiovasc Interv. 2012;5:641-648.)