Impact of the community's socioeconomic status on characteristics and outcomes of patients undergoing percutaneous coronary intervention

Abstract

Individual socioeconomic factors have been associated with adverse cardiovascular outcomes. It is however unclear how the socioeconomic status of a community influences the characteristics and outcome of patients treated with percutaneous coronary intervention (PCI). The Israel Central Bureau of Statistics assigns a socioeconomic index (SI) to communities based on demographic, economic and educational parameters. We determined the SI for 1397 consecutive patients who underwent PCI between 4/2004 and 10/2006; patients were divided into low, intermediate or high SI. Baseline and procedural characteristics, adherence to guidelines - recommended medications and major adverse cardiac events (MACE) were compared between groups. Multivariate analysis was used to adjust for baseline and procedural variables. Patients from low SI communities were younger (59±11, 64±12, 65±11years for low, middle and high SI groups respectively, P<0.01) and had higher rates of diabetes (P<0.04) and of smoking (P<0.01). A low SI was associated with a lower rate of drug eluting stent implantation (P<0.01), lower adherence to aspirin and clopidogrel therapy, a higher rate of repeat revascularization (P=0.04) and a higher rate of recurrent myocardial infarction. A lower SI was an independent predictor of MACE (H.R 1.52 - 95% CI 1.03-2.25). Among patients undergoing PCI, a low community socioeconomic level is associated with a higher prevalence of cardiovascular risk factors, lower adherence to guidelines recommended therapy and is an independent predictor of MACE during follow up.