The role of the socio-economic environment on medical outcomes after ST-segment elevation myocardial infarction

Background: <br/>According to the World Health Organization, coronary artery disease (CAD), including ST-segment <br/>elevation myocardial infarction (STEMI), is the most common cause of death worldwide as well as in Europe and <br/>Austria. There is valid data on the impact of conventional risk factors on the medical outcomes for STEMI patients. <br/>However, only few studies examine the role of the socio-economic environment for medical outcomes. The main <br/>task of this study is to investigate if the socio-economic environment of patients who underwent percutaneous <br/>coronary intervention (PCI) after STEMI has an impact on the distribution of risk factors and medical outcomes. <br/>Methods: <br/>The study focuses on the population of the City of Vienna, Austria, and includes 870 STEMI patients, who <br/>underwent PCI at the General Hospital of Vienna (AKH Wien) between 2008 and 2012. The following data were <br/>collected: conventional risk factors (hypertension, hyperlipidemia, diabetes, overweight, smoking, family history and <br/>vascular disease) and socio-economic indicators of the patient's <br/>residential district (number of residents, income <br/>pre-tax, residents per general practitioner, residents per internal specialist, compulsory education only, academic <br/>degree and rate of unemployment). Cox regressions were performed to evaluate the impact of socio-economic <br/>environment and conventional risk factors on survival. <br/>Results: <br/>Most of the conventional risk factors show a significant difference between deceased and surviving patients. <br/>The study revealed significant differences across districts in relation to the socio-economic background of STEMI <br/>patients. Surprisingly, medical outcomes, as measured by the survival of patients, are significantly related to a patient's <br/>district of residence ( <br/>p <br/>-Value = 0.028) but not in a systematic way as far as the socio-economic environment of These <br/>districts is concerned. <br/>Conclusions: <br/>The study provides intuitive evidence for a hitherto understudied Central European context on the link <br/>between socio-economic environment and conventional risk factors at population level and the link between <br/>conventional risk factors and survival both at the population at the individual level. While this is in line with previous <br/>evidence and suggestive of the incorporation of measures of socio-economic status (SES) into policy & guidelines <br/>toward the management of CAD, more data on the SES - <br/> <br/>STEMI nexus are needed at individual level.