Exploring the impact of the Index of Multiple Deprivation on percutaneous coronary intervention outcomes: Insights from the British Cardiovascular Intervention Society database

Abstract

Background: The effect of socioeconomic status on percutaneous coronary intervention (PCI) outcomes in populations with universal healthcare is poorly understood. Previous studies have primarily focused on ST-segment elevation myocardial infarction (STEMI) patients.

Methods: We analysed PCI outcomes from the British Cardiovascular Intervention Society database (2007–2014), categorised by deprivation quintiles. The primary endpoint was 30-day all-cause mortality, with hazard ratios calculated using Cox regression, adjusting for hospital clustering.

Results: Among 437,024 eligible patients, with 1.78 million person-years of follow-up, 39.9% underwent PCI for stable coronary artery disease (CAD), 38.4% for non-STEMI, and 21.6% for STEMI. During a median follow-up of 3.5 years, 52,258 patients (11.9%) died. Crude mortality rates increased with greater deprivation (from 26.7 per 1,000 person-years in the least deprived to 28.5 per 1,000 in the most deprived; p for trend<0.0001). Increased mortality rates with worsening IMD were observed only in patients treated for non-STEMI. Adjusted for various covariates, including age, sex and PCI indication, 30-day mortality rates were 14% higher (HR: 1.14; 95% CI:1.06 to 1.24; p< 0.0001) in the most deprived patients compared to the least deprived. Similar patterns were observed for 1-year (HR:1.09; 95% CI:1.04 to 1.14) and 5-year mortality (HR:1.10; 95% CI:1.06 to 1.16).

Conclusion: Socioeconomic deprivation independently increases mortality risk after non-STEMI, but doesn't affect outcomes for stable CAD or STEMI in universal healthcare settings. Targeted strategies are needed to address this disparity.