Alboni Paolo, Amadei Andrea, Scarfò Salvatore, Bettiol Katia, Ippolito Franco, Baggioni Gianfranco
Division of Cardiology and Arrhythmologic Center, Civic Hospital, Centro, FE, Italy.
Ital Heart J. 2003 Aug;4(8):551-8.
It has been widely demonstrated that in the general population a low socioeconomic status (SES) represents a risk factor for coronary heart disease (CHD). Both the incidence of and the mortality due to CHD are significantly higher in subjects with a low SES. Conventional risk factors only partly account for the social gradient in CHD. The aim of this study was to evaluate whether mortality was associated with SES in patients with acute myocardial infarction (AMI).
To this purpose the articles dealing with AMI and SES, having a prospective cohort design, total mortality or sudden death as primary endpoint and multivariate analysis as statistical approach, were analyzed.
Among the patients hospitalized for AMI, a low SES was associated with more advanced disease, as shown by a significantly higher prevalence of heart failure and of recurrent ischemic events. The in-hospital treatment and prescriptions at discharge were similar among the various socioeconomic groups. The pre-hospitalization, in-hospital and long-term mortality were significantly higher in the most deprived subjects and a low SES represented an independent predictor (adjusted odds ratio ranging from 1.4 to 3.1). The few available data suggest the socioeconomic gradient as being a predictor even of sudden death.
A low SES represents an independent predictor of mortality in patients with AMI. The current prognostic stratification of AMI patients is rather disappointing. In order to get a more precise prognostic stratification and to approach an adequate prophylaxis, a low SES should be utilized; however, the mechanisms mediating the adverse outcome of low socioeconomic groups should be further investigated.
大量研究表明，在普通人群中，社会经济地位低下（SES）是冠心病（CHD）的危险因素。SES较低的人群中，冠心病的发病率和死亡率均显著更高。传统危险因素只能部分解释冠心病的社会梯度差异。本研究旨在评估急性心肌梗死（AMI）患者的死亡率是否与SES相关。
为此，对采用前瞻性队列设计、以全因死亡率或心源性猝死作为主要终点、并采用多因素分析作为统计方法的关于AMI与SES的文章进行分析。
在因AMI住院的患者中，SES较低与病情更严重相关，心力衰竭和复发性缺血事件的患病率显著更高即表明了这一点。不同社会经济群体的住院治疗及出院处方相似。最贫困人群的院前、住院及长期死亡率显著更高，SES较低是独立的预测因素（校正比值比为1.4至3.1）。现有的少量数据表明社会经济梯度甚至是心源性猝死的预测因素。
SES较低是AMI患者死亡率的独立预测因素。目前AMI患者的预后分层相当令人失望。为了获得更精确的预后分层并采取适当的预防措施，应考虑SES较低这一因素；然而，介导社会经济地位较低群体不良结局的机制仍需进一步研究。
