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)?


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.


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).


Higher educational status is associated with better short- and long-term outcome in patients with STEMI.


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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