Cardiovascular revascularization medicine : including molecular interventions · 2025
Impact of social determinants of health in patients undergoing percutaneous coronary intervention.
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Kumar Sant, Kearney Kathleen E, Chung Christine J, Elison David, Steinberg Zachary L, Lombardi William L, McCabe James M, Yengle Luz Maria Vilca, Azzalini Lorenzo
Аннотация
BACKGROUND: Social determinants of health (SDOH) influence the outcomes of patients undergoing cardiovascular procedures. The area deprivation index (ADI) is a multidimensional tool designed to evaluate SDOH at the census block level, which has received limited study in cardiology. This study evaluated the impact of the ADI on short-term clinical outcomes after percutaneous coronary intervention (PCI).
METHODS: We analyzed patients who underwent PCI at a single center between April 2018 and June 2024. ADI was calculated for socioeconomic assessment, with patients stratified into quartiles. The primary endpoint was 30-day all-cause mortality. Multivariable analysis was used to control for confounders.
RESULTS: We included 4902 patients. The cohort's mean age was 67.8 ± 11.2 years, and 23.2 % were women. Patients in the fourth (the most deprived) ADI quartile were more likely to be Hispanic/Latino, have Medicaid/Medicare as primary insurance, and had higher rates of diabetes, prior PCI, and cardiogenic shock on presentation. They also exhibited higher procedural complexity. At 30 days, patients in the most deprived ADI quartile had the highest mortality and cardiovascular death rates (p < 0.001). On multivariable analysis, belonging to the most deprived ADI quartile was independently associated with 30-day all-cause mortality (odds ratio 1.21, 95 % confidence interval 1.10-1.71, p = 0.023), after controlling for demographics, clinical, and procedural variables.
CONCLUSIONS: Patients with high socioeconomic deprivation exhibit higher clinical and procedural complexity and have a higher risk for short-term mortality after PCI, even after controlling for confounders.
METHODS: We analyzed patients who underwent PCI at a single center between April 2018 and June 2024. ADI was calculated for socioeconomic assessment, with patients stratified into quartiles. The primary endpoint was 30-day all-cause mortality. Multivariable analysis was used to control for confounders.
RESULTS: We included 4902 patients. The cohort's mean age was 67.8 ± 11.2 years, and 23.2 % were women. Patients in the fourth (the most deprived) ADI quartile were more likely to be Hispanic/Latino, have Medicaid/Medicare as primary insurance, and had higher rates of diabetes, prior PCI, and cardiogenic shock on presentation. They also exhibited higher procedural complexity. At 30 days, patients in the most deprived ADI quartile had the highest mortality and cardiovascular death rates (p < 0.001). On multivariable analysis, belonging to the most deprived ADI quartile was independently associated with 30-day all-cause mortality (odds ratio 1.21, 95 % confidence interval 1.10-1.71, p = 0.023), after controlling for demographics, clinical, and procedural variables.
CONCLUSIONS: Patients with high socioeconomic deprivation exhibit higher clinical and procedural complexity and have a higher risk for short-term mortality after PCI, even after controlling for confounders.