Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina 27715, USA.
J Am Coll Cardiol. 2011 Jan 11;57(2):138-46. doi: 10.1016/j.jacc.2010.09.021.
The purpose of this study was to examine the association between lower socioeconomic status (SES), as ascertained by years of education, and outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI).
Previous studies have shown an inverse relationship between SES and coronary heart disease and mortality. Whether a similar association between SES and mortality exists in STEMI patients is unknown.
We evaluated 11,326 patients with STEMI in the GUSTO-III (Global Use of Strategies to Open Occluded Coronary Arteries) trial study from countries that enrolled >500 patients. We evaluated clinical outcomes (adjusted using multivariate regression analysis) according to the number of years of education completed.
One-year mortality was inversely related to years of education and was 5-fold higher in patients with <8 years compared with those with >16 years of education (17.5% vs. 3.5%, p < 0.0001). The strength of the relationship between education and mortality varied among different countries. Nonetheless, years of education remained an independent correlate of mortality at day 7 (hazard ratio per year of increase in education: 0.86; 95% confidence interval: 0.83 to 0.88) and also between day 8 and 1 year (hazard ratio per year of increase in education: 0.96; 95% confidence interval: 0.94 to 0.98), even after adjustment for baseline characteristics and country of enrollment.
When the number of years of education was used as a measure of SES, there was an inverse relationship such that significantly higher short-term and 1-year mortality existed beyond that accounted for by baseline clinical variables and country of enrollment. Future studies should account for and investigate the mechanisms underlying this link between SES and cardiovascular disease outcomes.
本研究旨在探讨通过受教育年限确定的较低社会经济地位（SES）与急性 ST 段抬高型心肌梗死（STEMI）患者结局之间的相关性。
先前的研究表明 SES 与冠心病和死亡率之间呈负相关。SES 与 STEMI 患者死亡率之间是否存在类似的关联尚不清楚。
我们评估了来自纳入超过 500 名患者的 GUSTO-III（全球采用策略开通闭塞冠状动脉）试验研究中的 11326 例 STEMI 患者。我们根据完成的受教育年限评估了临床结局（使用多变量回归分析进行校正）。
1 年死亡率与受教育年限呈负相关，与完成 >16 年受教育年限的患者相比，完成 <8 年受教育年限的患者的 1 年死亡率高 5 倍（17.5% vs. 3.5%，p < 0.0001）。教育程度与死亡率之间的关系强度因国家而异。尽管如此，在校正基线特征和入组国家后，受教育年限仍然是第 7 天死亡率的独立相关因素（受教育年限每年增加的风险比：0.86；95%置信区间：0.83 至 0.88），并且在第 8 天至 1 年期间也是如此（受教育年限每年增加的风险比：0.96；95%置信区间：0.94 至 0.98）。
当受教育年限被用作 SES 的衡量标准时，存在一种反比关系，即短期和 1 年死亡率显著升高，超出了基线临床变量和入组国家所能解释的范围。未来的研究应该考虑并调查 SES 与心血管疾病结局之间这种关联的机制。
