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Association of Mortality With Years of Education in Patients With ST-Segment Elevation Myocardial Infarction Treated With Fibrinolysis
Study Questions:
What is the impact of educational level on outcome of patients with ST-elevation myocardial infarction (STEMI)?
Methods:
The authors evaluated the association of years of education completed with outcome of 11,326 patients with STEMI who were enrolled in the GUSTO-III (Global Use of Strategies to Open Occluded Coronary Arteries) trial.
Results:
There was a strong inverse association between education level and 30-day or 1-year mortality. The 30-day mortality was 12% in those with less than 8 years of education compared with 2% in those with more than 16 years of education. One-year mortality was 17.5% in patients with <8 years compared with 3.5% in those with >16 years of education (p < 0.0001). After adjustment for baseline characteristics and country of enrollment, years of education completed were independently associated with 7-day mortality (hazard ratio [HR] per 1-year increase in education, 0.86; 95% confidence interval [CI], 0.83-0.88) and mortality between day 8 and 1 year (HR, 0.96; 95% CI, 0.94-0.98).
Conclusions:
Higher educational status is associated with better short- and long-term outcome in patients with STEMI.
Perspective:
This is an interesting study that has important implications for health care policy. In this study, educational status was only second to age in prognostic importance, suggesting a need to include this variable in risk-adjustment models. Furthermore, given the strength of the association, further research is needed to define and modify the mechanisms that mediate the association between educational status and outcome.
Keywords: Prognosis, Myocardial Infarction, Cardiology, Fibrinolysis, Confidence Intervals, Coronary Vessels, Coronary Occlusion, Educational Status, Risk Adjustment
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