Impact of the community's socioeconomic status on characteristics and outcomes of patients undergoing percutaneous coronary intervention

Background: Individual socioeconomic factors have been associated with adverse cardiovascular outcomes. It is however unclear how the socioeconomic status of a community influences the characteristics and outcome of patients treated with percutaneous coronary intervention (PCI). Methods: The Israel Central Bureau of Statistics assigns a socioeconomic index (SI) to communities based on demographic, economic and educational parameters. We determined the SI for 1397 consecutive patients who underwent PCI between 4/2004 and 10/2006; patients were divided into low, intermediate or high SI. Baseline and procedural characteristics, adherence to guidelines - recommended medications and major adverse cardiac events (MACE) were compared between groups. Multivariate analysis was used to adjust for baseline and procedural variables. Results: Patients from low SI communities were younger (59 ± 11, 64 ± 12, 65 ± 11-years for low, middle and high SI groups respectively, P < 0.01) and had higher rates of diabetes (P < 0.04) and of smoking (P < 0.01). A low SI was associated with a lower rate of drug eluting stent implantation (P < 0.01), lower adherence to aspirin and clopidogrel therapy, a higher rate of repeat revascularization (P = 0.04) and a higher rate of recurrent myocardial infarction. A lower SI was an independent predictor of MACE (H.R 1.52 - 95% CI 1.03-2.25). Conclusion: Among patients undergoing PCI, a low community socioeconomic level is associated with a higher prevalence of cardiovascular risk factors, lower adherence to guidelines recommended therapy and is an independent predictor of MACE during follow up.