教育对 ST 段抬高型心肌梗死（STEMI）后全因死亡率的影响：来自巴西心脏研究的结果。
The Impact of Education on All-cause Mortality Following St-Segment Elevation Myocardial Infarction (STEMI): Results from the Brazilian Heart Study.
机构信息
Universidade Estadual de Campinas (UNICAMP) - Laboratório de Aterosclerose e Biologia Vascular (Aterolab), Campinas, SP - Brasil.
Escola Superior de Ciências da Saúde, Brasília, DF - Brasil.
出版信息
Arq Bras Cardiol. 2021 Jul;117(1):5-12. doi: 10.36660/abc.20190854.
BACKGROUND
Low schooling has been considered an important modifiable risk factor for the development of cardiovascular disease for a long time. Despite that, whether this factor impacts the outcomes following ST-segment elevation myocardial infarction (STEMI) is poorly understood.
OBJECTIVE
To investigate whether schooling stands as an independent risk factor for mortality in STEMI patients.
METHODS
STEMI-diagnosed patients were consecutively enrolled from a prospective cohort (Brasilia Heart Study) and categorized according to years of study quartiles (0-3, 4-5, 6-10 and >10 years). Groups were compared by student's t test for continuous variables and qui-square for categorical. Incidence of all-cause mortality was compared with Kaplan-Meyer with Cox regression adjusted by age, gender, and GRACE score. Values of p < 0.05 were considered significant. SPSS21.0 was used for all analysis.
RESULTS
The mean schooling duration was 6.63±4.94 years. During the follow-up period (mean: 21 months; up to 6.8 years), 83 patients died (cumulative mortality of 15%). Mortality rate was higher among the lowest quartile compared to those in the highest quartile [18.5 vs 6.8%; HR 2.725 (95% CI: 1.27-5.83; p=0.01)]. In multivariate analysis, low schooling has lost statistical significance for all-cause mortality after adjustment for age and gender, with HR of 1.305 (95% CI: 0.538-3.16; p=0.556), and after adjustment by GRACE score with an HR of 1.767 (95% CI: .797-3.91; p=0.161).
CONCLUSION
Low schooling was not an independent risk factor for mortality in STEMI patients.
背景
长期以来，受教育程度较低一直被认为是导致心血管疾病发生的一个重要的可改变的危险因素。尽管如此，人们对这一因素是否会影响 ST 段抬高型心肌梗死（STEMI）患者的预后知之甚少。
目的
研究受教育程度是否是 STEMI 患者死亡的独立危险因素。
方法
连续入选来自前瞻性队列研究（巴西利亚心脏研究）的 STEMI 患者，并根据受教育年限分为 quartiles（0-3 年、4-5 年、6-10 年和>10 年）。采用 student's t 检验比较连续变量，采用 qui-square 检验比较分类变量。采用 Kaplan-Meier 法比较全因死亡率，并采用 Cox 回归模型调整年龄、性别和 GRACE 评分进行校正。p<0.05 为差异有统计学意义。所有数据分析均采用 SPSS21.0 软件进行。
结果
平均受教育年限为 6.63±4.94 年。在随访期间（平均 21 个月，最长 6.8 年），83 例患者死亡（累积死亡率为 15%）。与受教育程度最高 quartile 相比，最低 quartile 的死亡率更高[18.5% vs 6.8%；HR 2.725（95%CI：1.27-5.83；p=0.01)]。多因素分析显示，在校正年龄和性别后，低教育程度对全因死亡率的影响不再具有统计学意义（HR 1.305，95%CI：0.538-3.16；p=0.556），在校正 GRACE 评分后，HR 为 1.767（95%CI：0.797-3.91；p=0.161）。
结论
低教育程度不是 STEMI 患者死亡的独立危险因素。
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