title: Association of mortality with years of education in patients with ST-segment elevation myocardial infarction treated with fibrinolysis.
abstract: OBJECTIVE
  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.
authors.affiliation: Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina 27715, USA. mehta007@dcri.duke.edu
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: J Conor
authors.initials: JC
authors.lastname: O'Shea
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Stebbins
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D009520:New Zealand / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents