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Coronary artery disease
Socio-economic status and early outcome from coronary artery bypass grafting
  1. P H Gibson1,
  2. B L Croal2,
  3. B H Cuthbertson3,
  4. G Gibson4,
  5. R R Jeffrey4,
  6. K G Buchan4,
  7. H El-Shafei4,
  8. G S Hillis1
  1. 1
    Department of Cardiology, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, UK
  2. 2
    Department of Clinical Biochemistry, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, UK
  3. 3
    Health Services Research Unit, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, UK
  4. 4
    Department of Cardiac Surgery, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, UK
  1. Dr G Hillis, Cardiovascular Division, The George Institute for International Health, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Sydney NSW 2050, Australia; ghillis{at}george.org.au

Abstract

Objective: To determine the effects of socio-economic status (SES) on the outcome of coronary artery bypass grafting (CABG).

Design: Prospective cohort study.

Setting: Regional cardiac surgical unit.

Patients: 1994 consecutive patients undergoing non-emergency CABG.

Measures: SES was determined from the patient’s postcode using Carstairs tables. The primary end-point was all-cause mortality at 30 days.

Results: There were 50 deaths (2.5%) within 30 days of surgery. A higher Carstairs score demonstrated a trend towards increased 30-day mortality (odds ratio (OR) 1.09 per unit, 95% CI 1.00 to 1.20, p = 0.06). In a backward conditional model, including other predictors of early mortality, Carstairs scores were independently predictive (OR 1.12 per unit, 95% CI 1.01 to 1.24, p = 0.02). In a model including only Carstairs scores and the EuroSCORE, both were independent predictors of this outcome (OR for Carstairs score 1.11 per unit, 95% CI 1.00 to 1.22, p = 0.04). The 30-day mortality increases in each quartile of Carstairs scores, with patients in quartile 4 (most deprived) at significantly higher risk compared with quartile 1 (uncorrected OR 2.53 per unit, 95% CI 1.04 to 6.15; OR corrected for EuroSCORE, 2.56 per unit, 95% CI 1.03 to 6.34, p = 0.04 for both). Similarly, patients in the least affluent quartile were twice as likely to suffer a serious complication as those in the most affluent quartile (OR 2.14 per unit, 95% CI 1.32 to 3.46, p = 0.002). This increased risk was also independent of the EuroSCORE.

Conclusions: Lower SES is associated with a poorer early outcome following CABG and is independent of other recognised risk factors.

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Footnotes

  • See Editorial, p 785

  • Competing interests: None.

  • Ethics approval: Ethics approval was provided by the Grampian Research Ethics Committee.

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