title: Educational Level and Long-term Mortality in Patients With Acute Myocardial Infarction.
abstract: OBJECTIVE
  The value of socioeconomic status as a prognostic marker in acute myocardial infarction is controversial. The aim of this study was to evaluate the impact of educational level, as a marker of socioeconomic status, on the prognosis of long-term survival after acute myocardial infarction.
  
  
  METHODS
  We conducted a prospective, observational study of 5797 patients admitted to hospital with acute myocardial infarction. We studied long-term all-cause mortality (median 8.5 years) using adjusted regression models.
  
  
  RESULTS
  We found that 73.1% of patients had primary school education (n=4240), 14.5% had secondary school education (including high school) (n=843), 7.0% was illiterate (n=407), and 5.3% had higher education (n=307). Patients with secondary school or higher education were significantly younger, more were male, and they had fewer risk factors and comorbidity. These patients arrived sooner at hospital and had less severe heart failure. During admission they received more reperfusion therapy and their crude mortality was lower. Their drug treatment in hospital and at discharge followed guideline recommendations more closely. On multivariate analysis, secondary school or higher education was an independent predictor and protective factor for long-term mortality (hazard ratio=0.85; 95% confidence interval, 0.74-0.98).
  
  
  CONCLUSIONS
  Our study shows an inverse and independent relationship between educational level and long-term mortality in patients with acute myocardial infarction.
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain. Electronic address: lconsue@gmail.com.
authors.forename: Luciano
authors.initials: L
authors.lastname: Consuegra-Sánchez
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Melgarejo-Moreno
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Galcerá-Tomás
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Alonso-Fernández
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Díaz-Pastor
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Germán
authors.initials: G
authors.lastname: Escudero-García
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Jaulent-Huertas
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Vicente-Gilabert
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality*; D009790:Occupations / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
keywords: Educational level; Infarto de miocardio; Myocardial infarction; Nivel de estudios; Nivel socioeconómico; Prognosis; Pronóstico; Socioeconomic status