Abstract EP36: Socioeconomic Status And Spontaneous Coronary Artery Dissection Outcomes

Abstract

Introduction: Spontaneous coronary artery dissection (SCAD) is an emerging cause of myocardial infarction. The epidemiology of SCAD is elucidated with recent investigations and analyses. However, the association between socioeconomic status (SES) and SCAD remains to be studied. We performed this study to identify the effects of SES on SCAD. Methods: We conducted a retrospective analysis of the 2016 to 2018 National Inpatient Sample database and the 2018 to 2019 Nationwide Readmission Database (NRD). Study populations were selected using ICD-10 diagnosis code and ICD-10 procedure code for MCS. Socioeconomic status was evaluated using median household income of patient’s ZIP code and dived into quarter. Discharge-level weight analysis was used to produce a national estimate. We conducted univariate and multivariable hierarchical regression analysis to calculate odds ratio (OR) with STATA 17. Results: During the study period, total 106,970,745 patients were hospitalized of which 30.17% were from 1 st (lowest), 26.26% from 2 nd , 23.76% from 3 rd and 19.82 from 4 th (highest) quartile. 0.02 % (24,560 of 106,970,745) patients were diagnosed with spontaneous coronary artery dissection. When lowest SES was compared to the highest SES quartile, the patients from the lowest SES tended to be diabetic (34.17 % v 18.39%) and younger (48.39 ± 0.01 v 50.16 ± 0.01) and less prevalence of hyperlipidemia (2.79% v 3.86%). The prevalence of hypertension (29.78% v 28.31%) and proportion of male (43.59% v 43.33%) were similar. After adjusting for age, sex and comorbid burden, the lowest SES quartile was associated with lower risk of SCAD when it was compared to highest quartile (OR 0.70; 95% CI 0.65-0.76; p<0.0001). However, the lowest SES quartile was associated with higher in-hospital mortality (OR 1.51; 95%CI 1.07-2.15; p=0.02) and 30-day readmission rate (OR 1.56; 95%CI 1.39 -1.88; p<0.0001) with SCAD when it compared to the highest quartile. Discussion: In this study, the lowest SES was associated with lower risk of SCAD. Individuals with low SES carry substantial burden of cardiovascular diseases. It is possible that SCAD is underdiagnosed in low SES population due to the presence of traditional cardiovascular risk factors. The unfavorable effects of low SES on SCAD can be identified with in-hospital mortality and rate of 30-day readmission. Further research is required to better understand the impact of SES on the outcomes of SCAD.