In industrialized nations, a low socioeconomic status represents an independent predictor of mortality in patients with acute myocardial infarction.
BACKGROUND
It has been widely demonstrated that in the general population a low socioeconomic status (SES) represents a risk factor for coronary heart disease (CHD). Both the incidence of and the mortality due to CHD are significantly higher in subjects with a low SES. Conventional risk factors only partly account for the social gradient in CHD. The aim of this study was to evaluate whether mortality was associated with SES in patients with acute myocardial infarction (AMI).


METHODS
To this purpose the articles dealing with AMI and SES, having a prospective cohort design, total mortality or sudden death as primary endpoint and multivariate analysis as statistical approach, were analyzed.


RESULTS
Among the patients hospitalized for AMI, a low SES was associated with more advanced disease, as shown by a significantly higher prevalence of heart failure and of recurrent ischemic events. The in-hospital treatment and prescriptions at discharge were similar among the various socioeconomic groups. The pre-hospitalization, in-hospital and long-term mortality were significantly higher in the most deprived subjects and a low SES represented an independent predictor (adjusted odds ratio ranging from 1.4 to 3.1). The few available data suggest the socioeconomic gradient as being a predictor even of sudden death.


CONCLUSIONS
A low SES represents an independent predictor of mortality in patients with AMI. The current prognostic stratification of AMI patients is rather disappointing. In order to get a more precise prognostic stratification and to approach an adequate prophylaxis, a low SES should be utilized; however, the mechanisms mediating the adverse outcome of low socioeconomic groups should be further investigated.
Alboni
Paolo
P
Division of Cardiology and Arrhythmologic Center, Civic Hospital, Centro, FE, Italy. p.alboni@ausl.fe.it
Amadei
Andrea
A
Scarfò
Salvatore
S
Bettiol
Katia
K
Ippolito
Franco
F
Baggioni
Gianfranco
G
D000208:Acute Disease; D003645:Death, Sudden / Q000453:epidemiology*; D019049:Developed Countries / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class