title: Gender, socioeconomic position, revascularization procedures and mortality in patients presenting with STEMI and NSTEMI in the era of primary PCI. Differences or inequities?
abstract: BACKGROUND
  Several studies have reported gender and socioeconomic differences in the use of revascularization procedures in patients with acute myocardial infarction. However, it is not clear whether these differences influence patients' survival. Moreover, most of the studies neither considered STEMI and NSTEMI separately, nor included primary PCI, which nowadays is the treatment of choice in case of AMI. In an unselected population of patients admitted to hospital with a first episode of STEMI and NSTEMI we examined gender and socioeconomic differences in the use of cardiac invasive procedures and in one-year mortality.
  
  
  METHODS
  Subjects hospitalized with a first episode of STEMI (n=3506) or NSTEMI (n=2286) were selected from the Piedmont (Italy) hospital discharge database. We considered the percentage of patients undergoing PCI, primary PCI and CABG, and in-hospital mortality. Out of hospital mortality was calculated through record linkage with the regional register. The relation between outcomes and gender or educational level was investigated using appropriate multivariate regression models adjusting for available confounders.
  
  
  RESULTS
  After adjustment for age, comorbidity and hospital characteristics, women and low educated patients had a lower probability of undergoing revascularization procedures. However, neither in-hospital, nor 30-day, nor 1-year mortality showed gender or social disparities.
  
  
  CONCLUSIONS
  Despite gender and socioeconomic differences in the use of revascularization, no differences emerged in in-hospital and 1-year mortality. These findings could suggest that patients are differently, but equitably, treated; differences are more likely due to an inability to fully adjust for clinical conditions rather than to a selection process at admission.
authors.affiliation: Epidemiology Unit, Regione Piemonte, Grugliasco (TO) ASL TO3, Italy. Electronic address: roberto.gnavi@epi.piemonte.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gnavi
authors.affiliation: Epidemiology Unit, Regione Piemonte, Grugliasco (TO) ASL TO3, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Rusciani
authors.affiliation: Epidemiology Unit, Regione Piemonte, Grugliasco (TO) ASL TO3, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Dalmasso
authors.affiliation: Cardiology Department, Maria Vittoria Hospital, Torino ASL TO2, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Giammaria
authors.affiliation: Cardiology Department, San Giovanni Bosco Hospital, Torino ASL TO2, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Anselmino
authors.affiliation: ProCure Solutions sas, Bergamo, Italy.
authors.forename: Daniela Paola
authors.initials: DP
authors.lastname: Roggeri
authors.affiliation: Epidemiology Unit, Regione Piemonte, Grugliasco (TO) ASL TO3, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Roggeri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities / Q000191:economics; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D009204:Myocardial Revascularization / Q000191:economics / Q000379:methods / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000191:economics / Q000379:methods* / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: Gender; Mortality; Myocardial infarction; Myocardial revascularization; Socioeconomic factor