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Socioeconomic status and early outcome from coronary artery bypass grafting
  1. PH Gibson,
  2. BL Croal,
  3. BH Cuthbertson,
  4. GA Gibson,
  5. RR Jeffrey,
  6. KG Buchan,
  7. H El-Shafei,
  8. GS Hillis
  1. Aberdeen Royal Infirmary, Aberdeen, UK

Abstract

Background Lower socioeconomic status (SES) has been associated with an increased risk of cardiovascular morbidity and mortality in a variety of settings. Data relating SES to outcome following surgical revascularisation are, however, limited and conflicting. We hypothesised that levels of deprivation would predict early outcome in this setting.

Methods Baseline clinical details were obtained prospectively in 1994 consecutive patients undergoing non-emergency coronary artery bypass grafting (CABG). SES was determined from the patient’s postal code using Carstairs tables, a well validated measure of SES. 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 independent predictors (OR 1.12 per unit, 95% CI 1.01 to 1.24, p = 0.02). In a model including only Carstairs scores and 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 risk of death at 30 days increases in each quartile of Carstairs scores, with patients in quartile 4 (the 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 is 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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