Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 57, Issue 2, Pages 138-146Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2010.09.021
Keywords
acute myocardial infarction; fibrinolysis; outcomes; socioeconomic status
Categories
Funding
- Duke Clinical Research Institute, Durham, North Carolina
- Astellas Pharma US
- AstraZeneca
- Boehringer Ingelheim
- Bristol-Myers Squibb
- GlaxoSmithKline
- Lilly
- Medtronic Vascular Inc.
- Merck Co.
- Sanofi-Aventis
- Medicines Co.
- Hoffmann-La Roche
- Novartis Pharmaceutical Co.
- Otsuka Pharmaceuticals
- Sanofi-Avenits
- Eli Lilly
- NIH
- Pfizer
- Roche
- Johnson Johnson
- Schering-Plough
- Merck Sharpe Dohme
- Daiichi Sankyo Pharma Development
- Bristol-Squibb
- Regado Biosciences
- JJ-Scios
- Merck
- Novartis
- Annenberg
- Aterovax
- Bayer/Ortho McNeil
- WebMD
- Kowa Research Institute
- McKinsey Co.
- Medtronic
- CV Therapeutics
- Daiichi Sankyo
- Datascope
- Eli Lilly Co.
- Medcines Co.
- Abiomed
- Gilead Sciences
- Liposcience
- Northpoint Domain
- Pozen Inc.
- Response Biomedical
- WedMD
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Objectives The purpose of this study was to examine the association between lower socioeconomic status (SES), as ascertained by years of education, and outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI). Background Previous studies have shown an inverse relationship between SES and coronary heart disease and mortality. Whether a similar association between SES and mortality exists in STEMI patients is unknown. Methods We evaluated 11,326 patients with STEMI in the GUSTO-III (Global Use of Strategies to Open Occluded Coronary Arteries) trial study from countries that enrolled >500 patients. We evaluated clinical outcomes (adjusted using multivariate regression analysis) according to the number of years of education completed. Results One-year mortality was inversely related to years of education and was 5-fold higher in patients with <8 years compared with those with >16 years of education (17.5% vs. 3.5%, p < 0.0001). The strength of the relationship between education and mortality varied among different countries. Nonetheless, years of education remained an independent correlate of mortality at day 7 (hazard ratio per year of increase in education: 0.86; 95% confidence interval: 0.83 to 0.88) and also between day 8 and 1 year (hazard ratio per year of increase in education: 0.96; 95% confidence interval: 0.94 to 0.98), even after adjustment for baseline characteristics and country of enrollment. Conclusions When the number of years of education was used as a measure of SES, there was an inverse relationship such that significantly higher short-term and 1-year mortality existed beyond that accounted for by baseline clinical variables and country of enrollment. Future studies should account for and investigate the mechanisms underlying this link between SES and cardiovascular disease outcomes. (J Am Coll Cardiol 2011;57:138-46) (C) 2011 by the American College of Cardiology Foundation
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