TCT-840 Index of Multiple Deprivation and Percutaneous Coronary Intervention: An Analysis From the British Cardiovascular Intervention Society Database

Author(s) Anderson S.; Garg S.; Saluja S.; Aghamohammadzadeh R.; Thiru S. et al.
Source Journal of the American College of Cardiology; Oct 2019; vol. 74 (no. 13)
DOI 10.1016/j.jacc.2019.08.990
Background: The impact of socioeconomic class on outcomes of percutaneous coronary intervention (PCI) in populations with access to universal unrestricted health care is limited. Furthermore, prior reports have focused mainly on patients with ST-segment elevation myocardial infarction (STEMI).

Method(s): We performed a retrospective analysis of centrally tracked outcomes from index PCI procedures entered in the British Cardiovascular Intervention Society database between 2007 and 2014 stratified according to quintiles of index of multiple deprivation (IMD; from the least deprived to the most deprived). The analyses were restricted to procedures performed in England. The primary endpoint was 30-day all-cause mortality, with secondary endpoints of mortality at 1 and 5 years. Hazard ratios (HRs) for mortality were determined from multivariate Cox regression models allowing for clustering by hospital.

Result(s): Among 437,024 eligible patients with 1.78 million person-years of observation, 40% of patients had PCI for stable coronary artery disease (CAD), 37.7% with non-STEMI, and 21.6% were treated for STEMI. A total of 52,258 patients (11.9%) died during a median of 3.5 years (interquartile range: 1.8 to 5.5 years) of follow-up. There was a trend toward an increase in crude mortality rates (per 1,000 person-years) with increasing quintile of IMD (from 26.7 per 1,000 in least deprived to 28.5 per 1,000 in the most deprived; p for trend <0.0001. When assessed by indication for PCI, only those undergoing intervention for non-STEMI or unstable angina had increased mortality rates as IMD worsened. In an age-, sex-, and indication for PCI-adjusted Cox regression multivariate analysis, mortality rates at 30 days were 14% greater (HR: 1.14; 95% confidence interval [CI]: 1.06 to 1.24; p < 0.0001) in patients from the most deprived areas compared with those with the least deprived IMD. These findings were similar for mortality at 1 year (HR: 1.09; 95% CI: 1.04 to 1.14) and at 5 years (HR: 1.10; 95% CI: 1.06 to 1.16).

​Conclusion(s): This very large, real-world dataset of patients demonstrates that deprivation is an independent marker of mortality following presentation with non-STEMI, and efforts should be directed at overcoming this. Reassuringly, in the setting of universal health care, deprivation does not influence outcomes from stable or STEMI presentation. Categories: OTHER: Political, International and Societal IssuesCopyright © 2019

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