Schmucker J, et al. - This investigation explored the link between socioeconomic status (SES) in different city-districts of Bremen/Germany and incidence, severity, treatment modalities and prognosis for patients with ST-elevation myocardial infarctions (STEMI), using the Bremen STEMI-registry data. The findings corroborated a negative association of low socioeconomic status and STEMI-incidence, with higher rates of smoking and obesity, more extensive infarctions and worse prognosis for the socio-economically deprived.

Methods

• In the Bremen STEMI-registry, all STEMI-patients from the metropolitan area of Bremen were documented since 2006.
• Postal codes of their home address were utilized to assign them to four groups in accordance to the Bremen social deprivation-index (G1: high, G2: intermediate high, G3: intermediate low, G4: low socioeconomic status).

Results

• This analysis included 3462 consecutive patients with STEMI admitted between 2006 and 2015.
• As per findings, city areas with low SES showed higher adjusted STEMI-incidence-rates (IR-ratio 1.56, G4 vs. G1).
• Data reported that this elevation could be observed in both sexes (women IRR 1.63, men IRR 1.54) and was most prominent in inhabitants <50 yrs. of age (women IRR 2.18, men IRR 2.17).
• The reported prevalence of smoking (OR 1.7, 95%CI 1.3–2.4) and obesity (1.6, 95%CI 1.1–2.2) was more in pts. from low SES city-areas.
• Researchers found no difference in treatment-modalities but noted that low SES was associated with more extensive STEMIs (creatine kinase > 3000 U/l, OR 1.95, 95% CI 1.4–2.8) and severe impairment of LV-function post-STEMI (OR 2.0, 95% CI 1.2–3.4).
• Lower SES was associated with higher major adverse cardiac or cerebrovascular event (MACCE)-rates after 5 years, as revealed in long term follow-up: G1 30.8%, G2 35.7%, G3 36.0%, G4 41.1%, p (for trend) = 0.02.
• As per results, this worse prognosis could especially be shown for young STEMI-patients (<50 yrs. of age) 5-yr. mortality-rates(G4 vs. G1) 18.4 vs. 3.1%, p = 0.03 and 5-year-MACCE-rates (G4 vs. G1) 32 vs. 6.3%, p = 0.02.