Socioeconomic disparities in 1-year outcomes after PCI.
S Janssen, D A M Peeters, E C I Woelders, P J C Winkler, J J P Luijkx, W S Remkes, P Damman, S Rasoul, R J M van Geuns, A W J van 't HofAbstract
Background
Socioeconomic inequalities are strongly associated with cardiovascular disease. However, whether socioeconomic status (SES) independently influences outcome after percutaneous coronary intervention (PCI) remains unclear.
Purpose
To investigate the association between SES and 1-year cardiovascular outcomes after PCI, and to determine whether observed disparities are explained by differences in cardiovascular risk burden.
Methods
Data were derived from the Southeast Netherlands Heart Registry (ZON-HR), an ongoing multicentre PCI registry. SES was determined through linkage of residential postal codes to national socioeconomic data from Statistics Netherlands (CBS). Patients with available SES score and complete 1-year follow up were included. SES was analysed as a continuous variable. Associations between SES and baseline characteristics, and between SES and 1-year outcomes were assessed using logistic regression. The risk of major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of myocardial infarction, stent thrombosis, unplanned revascularisation, ischemic stroke, or cardiovascular mortality, was evaluated after multivariable adjustment.
Results
A total of 6,424 patients were included. Lower SES was strongly associated with a less favourable cardiovascular risk profile, including higher odds of acute coronary syndrome (OR 1.37, 95% CI 1.07–1.75), peripheral artery disease (OR 1.66, 95% CI 1.13–2.44), hypertension (OR 1.74, 95% CI 1.35–2.23), obesity (OR 1.80, 95% CI 1.37-2.36), diabetes (OR 2.35, 95% CI 1.77–3.13), and active smoking (OR 4.00, 95% CI 2.96–5.39). Furthermore, lower SES was associated with higher unadjusted risk of MACCE (OR 1.44, 95% CI 1.01-2.04), mainly driven by ischemic stroke and cardiovascular mortality. After multivariable adjustment, SES was no longer independently associated with MACCE (adjusted OR 1.51, 95% CI 0.86-2.65).
Conclusion
In a contemporary PCI cohort, lower SES was associated with a substantially higher cardiovascular risk burden and worse unadjusted 1-year outcomes. However, the association with MACCE was attenuated after adjustment for traditional risk factors, suggesting that socioeconomic disparities in post-PCI outcomes are predominantly mediated by modifiable cardiovascular risk profiles. These findings highlight the importance of intensified primary and secondary prevention strategies targeting socially vulnerable populations.Figure 1 Forest plot baseline characteristicsFigure 2 Forest plot outcomes