https://doi.org/10.1007/s00392-025-02625-4
1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland; 2Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland
Methods All consecutive patients diagnosed with acute MI and admitted to the heart center in Bremen from 2015 to 2022 were included. Patients were stratified into four groups based on the Bremen Social Deprivation Index (G1: high, G2: intermediate, G3: low, G4: very low SES), which includes income, employment, housing, education, political involvement and security. Long-term MACCE outcomes were analyzed by SES group in a multivariable survival analysis adjusted for age, sex, traditional risk factors, interventional success and infarction severity.
Results A total of 2807 patients were included. Lower SES was associated with 5.5 years younger age (G1: 68.8 ± 13.3 vs. G4: 63.3 ± 12.4 years, p < .001 for trend). Excluding patients with known atherosclerotic disease prior to the index event, the age difference increased to 5.9 years (67.7 ± 12.4 vs. 61.8 ± 13.2 years, p < .001 for trend). BMI was higher in lower SES groups (G1: 26.6 ± 4.9 vs. G4: 29.0 ± 6.0, p < .001 for trend). Rates of diabetes mellitus and smoking rates were significantly elevated in patients from lower SES city districts (p < .001 for trend); HDL cholesterol was significantly lower in lower SES groups (p < .001 for trend), while no significant differences were observed for total cholesterol or LDL cholesterol (Table 1). No significant differences were found across SES groups for in-hospital mortality, Killip classification, ejection fraction, known atherosclerotic disease, acute kidney injury, number of diseased coronary arteries, or peak CK levels (all p > 0.3). However, in a multivariable survival analysis SES emerged as a significant and independent predictor of long-term MACCE. Compared to the reference group (G1: high SES), patients with low SES had a significantly higher risk (HR 1.97, 95% CI: 1.27-3.05, p = 0.002), while those with very low SES had an even higher risk (HR 2.31, 95% CI: 1.31-4.09, p = 0.004). No significant difference was observed for G2 (intermediate SES) compared to G1 (HR 1.13, 95% CI: 0.75-1.72, p = 0.562) (Figure 1).
Conclusion This study demonstrates that SES plays a crucial role in both the risk and long-term prognosis of MI. Lower SES was associated with younger age at first MI occurrence and a higher rate of modifiable cardiovascular risk factors. While in-hospital outcomes did not differ significantly by SES, long-term prognosis was significantly influenced by SES independently of traditional risk factors, infarction severity and interventional success. These findings highlight the need for more targeted interventions to address socioeconomic disparities in order to improve cardiovascular health.
Table 1. Baseline Characteristics and Risk Factor Profile by SES Level
Figure 1: Cumulative Hazard Curves Illustrating the Adjusted Events Rates Stratified for SES groups