Author + information
- Received January 8, 2010
- Revision received August 9, 2010
- Accepted September 2, 2010
- Published online January 11, 2011.
- Rajendra H. Mehta, MD, MS⁎,⁎ (, )
- J. Conor O'Shea, MD†,
- Amanda L. Stebbins, MS⁎,
- Christopher B. Granger, MD⁎,
- Paul W. Armstrong, MD‡,
- Harvey D. White, MB, DSc§,
- Eric J. Topol, MD∥,
- Robert M. Califf, MD⁎,¶ and
- E. Magnus Ohman, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Rajendra H. Mehta, Duke Clinical Research Institute, Box 17969, Durham, North Carolina 27715
Objectives 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.
Funded by the Duke Clinical Research Institute, Durham, North Carolina. Dr. Granger has received research grants from Astellas Pharma US, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Medtronic Vascular Inc., Merck & Co., Sanofi-Aventis, and The Medicines Co.; and consulting fees from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Hoffmann-La Roche, Novartis Pharmaceutical Co., Otsuka Pharmaceuticals, Sanofi-Aventis, and The Medicines Co. Dr. White has received research grants from Sanofi-Avenits, Eli Lilly, The Medicines Co., NIH, Pfizer, Roche, Johnson & Johnson, Schering-Plough, Merck Sharpe & Dohme, AstraZeneca, GlaxoSmithKline, Daiichi Sankyo Pharma Development, and Bristol-Myers Squibb; and consulting fees from Regado Biosciences. Dr. Califf has received research grants from J&J-Scios, Lilly, Merck, Novartis, and Schering-Plough; consulting fees from Annenberg, Aterovax, Bayer/Ortho McNeil, Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, WebMD, J&J-Scios, Kowa Research Institute, McKinsey & Co., Medtronic, Merck, Novartis, Sanofi-Aventis, and Schering-Plough; and has equity in NITROX LLC. Dr. Ohman has received research grants from Bristol-Myers Squibb, CV Therapeutics, Daiichi Sankyo, Datascope, Eli Lilly & Co., Sanofi-Avenits, Schering-Plough, and The Medcines Co.; and consulting fees from Abiomed, CV Therapeutics, Datascope, Gilead Sciences, Liposcience, Northpoint Domain, Pozen Inc., Response Biomedical, The Medicines Co., and WedMD. All other authors have reported that they have no relationships to disclose.
- Received January 8, 2010.
- Revision received August 9, 2010.
- Accepted September 2, 2010.
- American College of Cardiology Foundation