Gender, socioeconomic position, revascularization procedures and mortality in patients presenting with STEMI and NSTEMI in the era of primary PCI. Differences or inequities?

Background: Several studies have reported gender and socioeconomic differences in the use of revascularization procedures in patients with acute myocardial infarction. However, it is not clear whether these differences influence patients' survival. Moreover, most of the studies neither considered STEM! and NSTEMI separately, nor included primary PCI, which nowadays is the treatment of choice in case of AMI. In an unselected population of patients admitted to hospital with a first episode of STEMI and NSTEMI we examined gender and socioeconomic differences in the use of cardiac invasive procedures and in one-year mortality. Methods: Subjects hospitalized with a first episode of STEMI (n = 3506) or NSTEMI (n = 2286) were selected from the Piedmont (Italy) hospital discharge database. We considered the percentage of patients undergoing PC!, primary PCI and CABO, and in-hospital mortality. Out of hospital mortality was calculated through record linkage with the regional register. The relation between outcomes and gender or educational level was investigated using appropriate multivariate regression models adjusting for available confounders. Results: After adjustment for age, comorbitlity and hospital characteristic's, women and low educated patients had a lower probability of undergoing revascularization procedures. However, neither in-hospital nor 30-day, nor 1-year mortality showed gentler or social disparities. Conclusions: Despite gentler and socioeconomic differences in the use of revascularization, no differences emerged in in-hospital and 1-year mortality. These findings could suggest that patients are differently, but equitably, treated; differences are more likely clue to an inability to fully adjust for clinical conditions rather than to a selection process at admission. (C) 2014 Elsevier Ireland Ltd. AB rights reserved.