Socioeconomic Status and Long-Term Outcomes After ST-Segment Elevation Myocardial Infarction

Socioeconomic status (SES) influences cardiovascular risk, but its impact on contemporary ST-segment elevation myocardial infarction (STEMI) care remains uncertain. We examined SES-related differences in risk profile, acute care, and 5-year outcomes among consecutive STEMI patients treated at a regional referral heart center (2015-2022). SES was assigned using the neighborhood-level Social Deprivation Index and categorized as high, intermediate, low, or very low based on composite indicators of income, employment, housing, education, political participation, and security. The primary end point was major adverse cardiac and cerebrovascular events through 60 months, analyzed with multivariable models adjusting for demographics, traditional risk factors, interventional success, and infarct severity. Among 2,807 patients, 497 (17.7%) had low SES and 207 (7.4%) very low SES. Compared with high SES, very low SES patients were >5 years younger (63.3 ± 12.4 vs 68.8 ± 13.3 years; p < 0.001) and had higher body mass index, more diabetes, and more smoking (all p < 0.001). Acute presentation, infarct characteristics, and in-hospital outcomes were broadly comparable across SES strata. Over 5 years, low and very low SES were independently associated with higher major adverse cardiac and cerebrovascular events (MACCE) risk versus high SES (HR 1.85, 95% CI 1.28-2.68; and HR 2.45, 95% CI 1.54-3.92). In conclusion, socioeconomic disadvantage is associated with earlier presentation and worse long-term outcomes despite similar acute care, supporting targeted postdischarge secondary prevention.