Gender, socioeconomic position, revascularization procedures and mortality in patients presenting with STEMI and NSTEMI in the era of primary PCI. Differences or inequities? in International journal of cardiology / Int J Cardiol. 2014 Oct 20;176(3):724-30. doi: 10.1016/j.ijcard.2014.07.107. Epub 2014 Aug 4.
2014
ASL Città di Torino
ASL Torino 3
Tipo pubblicazione
Research Support, Non-U.S. Gov't
Autori/Collaboratori (7)Vedi tutti...
Roggeri A
Epidemiology Unit, Regione Piemonte, Grugliasco (TO) ASL TO3, Italy.
Roggeri DP
ProCure Solutions sas, Bergamo, Italy.
Anselmino M
Cardiology Department, San Giovanni Bosco Hospital, Torino ASL TO2, Italy.
et alii...
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.
Accesso banca dati bibliografica
Accedi alla scheda bibliografica del documento in PUBMED
PMID : 25183535
DOI : 10.1016/j.ijcard.2014.07.107
Keywords
Gender; Socioeconomic Factors; Sex Factors; Risk Factors; Prospective Studies; Percutaneous Coronary Intervention/economics/methods/mortality; Myocardial Revascularization/economics/methods/mortality; Myocardial Infarction/economics/mortality/therapy; Mortality/trends; Middle Aged; Socioeconomic factor; Myocardial revascularization; Myocardial infarction; Humans; Male; Hospital Mortality/trends; Healthcare Disparities/economics; Female; Aged, 80 and over; Aged; Mortality;