Impact of Marital Status on Management and Outcomes of Patients With Acute Myocardial Infarction: Insights From the China Acute Myocardial Infarction Registry

Abstract

Background Acute myocardial infarction (AMI) is one of the leading causes of mortality worldwide, whereas social support is a known predictor of the prognosis after AMI. As a common factor influencing social support, the impact of marital status on care quality, in‐hospital mortality, and long‐term prognosis of patients with AMI remains largely unknown. Methods and Results The present study analyzed data from the CAMI (China Acute Myocardial Infarction) registry involving 19 912 patients with AMI admitted at 108 hospitals in China between January 2013 and September 2014 and aimed to evaluate marital status–based differences in acute management, medical therapies, and short‐term and long‐term outcomes. The primary end point was 2‐year all‐cause death. The secondary end points included in‐hospital death and 2‐year major adverse cardiac and cerebrovascular events (a composite of all‐cause death, myocardial infarction, or stroke). After multivariable adjustment, 1210 (6.1%) unmarried patients received less reperfusion treatment in patients with both ST‐segment–elevation myocardial infarction and non–ST‐segment–elevation myocardial infarction (adjusted odds ratio [OR], 0.520 [95% CI, 0.437–0.618]; P <0.0001; adjusted OR, 0.489 [95% CI, 0.364–0.656]; P <0.0001). Being unmarried was not associated with poorer in‐hospital outcome but with long‐term all‐cause mortality and major adverse cardiac and cerebrovascular events in both ST‐segment–elevation myocardial infarction (adjusted hazard ratio [HR], 1.225 [95% CI, 1.031–1.456]; P =0.0209; adjusted HR, 1.277 [95% CI, 1.089–1.498]; P =0.0027) and non–ST‐segment–elevation myocardial infarction (adjusted HR, 1.302 [95% CI, 1.036–1.638]; P =0.0239; adjusted HR, 1.368 [95% CI, 1.105–1.694]; P =0.0040) populations. Conclusions The present study suggests that being unmarried is independently related to less reperfusion received, but could not explain the higher in‐hospital mortality rate after covariate adjustment. Being unmarried is associated with a substantially increased risk of adverse events over at least the first 24 months after AMI. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01874691.

Cardiovascular Disease in the Caribbean: Risk Factor Trends, Care and Outcomes Still Far From Expectations

“…This contrasts with the much lower prevalence of these risks in high-income countries, such as China (Figure 2). There is an even higher prevalence of CV risk among patients with AMI/CAD in the Caribbean: DM (13.5-47.8%), higher than in China (19.5%) [46]; hypertension (19.6%-75.9%) compared to China's 50.8% [46]; obesity (12.6%-48.3%) compared to China 20.0% [47]; smoking (28.9%-70.9%) compared to China (45.1%) [46]; cholesterol (37.8%) compared to China (8%) [46] (Figure 2). The high CV risks may have been fueled by an environment that encourages the development of CAD, such as fast food outlets, inadequate sporting facilities, sedentary lifestyles, and social stressors like murder, family disputes, divorce, child abuse, kidnapping, and rape [6].…”

“…This contrasts with the much lower prevalence of these risks in high-income countries, such as China (Figure 2 ). There is an even higher prevalence of CV risk among patients with AMI/CAD in the Caribbean: DM (13.5-47.8%), higher than in China (19.5%) [ 46 ]; hypertension (19.6%-75.9%) compared to China’s 50.8% [ 46 ]; obesity (12.6%-48.3%) compared to China 20.0% [ 47 ]; smoking (28.9%-70.9%) compared to China (45.1%) [ 46 ]; cholesterol (37.8%) compared to China (8%) [ 46 ] (Figure 2 ).…”

“…FIGURE 2: CV risk factors in the Caribbean vs. China among the national population and AMI/CAD patientsSource (China):[46][47][48][49][50][51][52] …”