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Socioeconomic Distress Associated With Increased Use of Percutaneous Coronary Intervention Over Coronary Artery

Raymond J Strobel1, J Hunter Mehaffey1, Robert B Hawkins2

  • 1Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.

The Annals of Thoracic Surgery
|July 22, 2022
PubMed

Insights

Socioeconomic distress, measured by the Distressed Communities Index (DCI), is linked to higher odds of receiving percutaneous coronary intervention (PCI) over coronary artery bypass grafting (CABG). This association also correlates with increased postprocedural mortality, suggesting a need for targeted interventions.

Area of Science:

  • Cardiology
  • Health Services Research
  • Socioeconomic Determinants of Health

Background:

  • Socioeconomic determinants of health (SDOH) impact healthcare choices, but their influence on selecting percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for coronary artery disease is not well understood.
  • The Distressed Communities Index (DCI), a zip code-based measure of socioeconomic factors, was used to quantify community distress.

Purpose of the Study:

  • To investigate the association between socioeconomic distress, as measured by DCI scores, and the choice between PCI and CABG for coronary artery disease.
  • To determine if higher levels of socioeconomic distress correlate with increased postprocedural mortality.

Main Methods:

  • A retrospective analysis of 23,223 patients undergoing isolated PCI or CABG between 2018-2021 from the ACC CathPCI registry and STS database.
  • Patients were assigned DCI scores based on education, poverty, unemployment, housing, income, and business growth. The most distressed quintile (DCI ≥80) was compared to others.
  • Multivariable logistic regression was employed to analyze the relationship between DCI and procedure type, adjusting for relevant factors.

Main Results:

  • Patients in the most distressed communities (DCI ≥80) had higher odds of receiving PCI compared to CABG, even after multivariable adjustment (OR 1.26; 95% CI, 1.07-1.49).
  • High socioeconomic distress was significantly associated with increased postprocedural mortality (OR 1.52; 95% CI, 1.02-2.26).
  • Initially, high socioeconomic distress was more prevalent in CABG patients before statistical adjustments.

Conclusions:

  • Higher socioeconomic distress is linked to an increased likelihood of undergoing PCI instead of CABG for coronary artery disease.
  • Patients from highly distressed communities face a greater risk of postprocedural mortality following these procedures.
  • Targeted resource allocation and interventions in high DCI areas may be crucial to address disparities and improve access to optimal cardiac care, potentially including CABG.
Abstract

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