Social Determinants of Health and Mortality After Premature and Non-premature Acute Coronary Syndrome

• Published in: Mayo Clinic proceedings. Innovations, quality & outcomes Vol. 7; no. 3; pp. 153 - 164
• Main Authors: Dugani, Sagar B., Zubaid, Mohammad, Rashed, Wafa, Girardo, Marlene E., Balayah, Zuhur, Mora, Samia, Alsheikh-Ali, Alawi A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.06.2023; Elsevier
• Subjects: Original; ACS; OR; aOR; GRACE; MI; AUC; BMI
• ISSN: 2542-4548; 2542-4548
• DOI: 10.1016/j.mayocpiqo.2023.03.002

To describe and compare the determinants of 1-year mortality after premature vs non-premature acute coronary syndrome (ACS). Participants presenting with ACS were enrolled in a prospective registry of 29 hospitals in 4 countries, from January 22, 2012 to January 22, 2013, with 1-year of follow-up data. The primary outcome was all-cause 1-year mortality after premature ACS (men aged <55 years and women aged <65 years) and non-premature ACS (men aged ≥55 years and women aged ≥65 years). The associations between the baseline patient characteristics and 1-year mortality were analyzed in models adjusting for the Global Registry of Acute Coronary Events (GRACE) score and reported as adjusted odds ratio (aOR) (95% CI). Of the 3868 patients, 43.3% presented with premature ACS that was associated with lower 1-year mortality (5.7%) than those with non-premature ACS. In adjusted models, women experienced higher mortality than men after premature (aOR, 2.14 [1.37-3.41]) vs non-premature ACS (aOR, 1.28 [0.99-1.65]) (Pinteraction=.047). Patients lacking formal education vs any education had higher mortality after both premature (aOR, 2.92 [1.87-4.61]) and non-premature ACS (aOR, 1.78 [1.36-2.34]) (Pinteraction=.06). Lack of employment vs any employment was associated with approximately 3-fold higher mortality after premature and non-premature ACS (Pinteraction=.72). Using stepwise logistic regression to predict 1-year mortality, a model with GRACE risk score and 4 characteristics (education, employment, body mass index [kg/m2], and statin use within 24 hours after admission) had higher discrimination than the GRACE risk score alone (area under the curve, 0.800 vs 0.773; Pcomparison=.003). In this study, women, compared with men, had higher 1-year mortality after premature ACS. The social determinants of health (no formal education or employment) were strongly associated with higher 1-year mortality after premature and non-premature ACS, improved mortality prediction, and should be routinely considered in risk assessment after ACS.