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045 Socio-economic status and outcome after percutaenous coronary intervention
  1. D A Jones,
  2. S Gallagher,
  3. K S Rathod,
  4. A K Jain,
  5. A Mathur,
  6. A Wragg
  1. Barts and the London NHS trust, UK

Abstract

Introduction The effect of socio-economic status upon outcome after PCI is poorly defined. Limited data exists suggesting an association between social deprivation and worse outcomes following both CABG and myocardial infarction. We sought to determine the effects of socio-economic status (SES) upon long-term outcome after percutaneous coronary intervention (PCI).

Method This was an observational registry consisting of 13 770 consecutive patients undergoing PCI at a single centre (January 2005 to August 2011). SES was assigned to each patient according to postcode and ranked according to the corresponding British Index of Multiple Deprivation (IMD) score, which comprises five deprivation quintiles (Q1, least deprived; Q5, most deprived). The primary outcome was all cause mortality data obtained from the Office of National Statistics via the BCIS/CCAD national audit. Follow-up was for a median of 3.7 years (IQR 2.0–5.1 years).

Results Patients were predominantly male (74.0%) and Caucasian (71.7%), with a mean (±SD) age of 63.8±12.0 years. Median IMD score was 24.4 (13.4 to 38.4), and the total score for each IMD quintile is shown in Abstract 045 table 1. The characteristics of the study population across the five IMD quintiles are also shown in Abstract 045 table 1. Patients in quintile 5 (most deprived) were younger, more likely to be of Asian descent, to be current smokers and had higher rates of previous MI, previous PCI, diabetes mellitus and renal failure. They were also more likely to present as an acute coronary syndrome and have either moderate or poor ejection fraction. Kaplan–Meier estimates of all cause mortality showed increasing rates of long-term mortality for each increase in IMD score quintile, with patients in quintile 5 demonstrating significantly higher long-term mortality compared with quintile 1 (p=0.0004) (Abstract 045 figure 1). Age-adjusted Cox analysis showed an increase in the hazard of death for quintile 5 compared to quintile 1 (HR 1.18 (95% CIs 1.01 to 1.39) and this was maintained with multiple adjustment (HR 1.62 (95% CIs 1.13 to 2.33).

Abstract 045 Table 1

Baseline Characteristics according to socio-economic quintile (*p value <0.05)

Abstract 045 Figure 1

Kaplan–Meier curve showing cumulative probability of all-cause mortality after PCI comparing quintiles of socioeconomic status.

Conclusions Lower SES is associated with higher long-term mortality following PCI and is independent of other recognised risk factors.

  • Socioeconomic status
  • percutaneous coronary intervention
  • mortality

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