Unmarried people may be at increased risk for adverse events 2 years after acute MI
Unmarried status may be an independent risk factor for poor 2-year outcomes following acute MI, according to a study published in the Journal of the American Heart Association.
“Lacking solid social support is a well-established contributor to cardiovascular mortality. Marriage is one of the closest and most important relationships for receiving social support,” Zhi-Yao Wei, MD, of the department of cardiology, Center for Coronary Heart Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, and colleagues wrote. “Marital status may affect medical decision-making, potentially contributing to the worse post-acute MI outcomes in unmarried patients than in married patients. ... The present study aimed to comprehensively explore the relationship between marital status and care quality, in-hospital mortality and long-term outcomes of patients hospitalized for acute MI in this large-scale registry.”
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For this analysis, Wei and colleagues used data from the China Acute Myocardial Infarction (CAMI) registry to assess 19,912 patients at 108 hospitals in China who were hospitalized with acute MI between January 2013 and September 2014 (mean age, 62 years; 75% men; 20% with diabetes).
The primary outcome was 2-year all-cause mortality, and secondary outcomes were in-hospital mortality and 2-year major adverse cardiac and cerebrovascular events, including all-cause mortality, MI or stroke.
Overall, 6.1% of the cohort was unmarried. Compared with their married counterparts, unmarried patients hospitalized with acute MI were more often older (74 vs. 62 years; P < .0001), less often men (50.7% vs. 76.5%; P < .0001), and STEMI was less frequently diagnosed (70.6% vs. 75.4%; P = .0002).
After adjustment, researchers observed that unmarried patients received less reperfusion treatment for both STEMI (adjusted OR = 0.52; 95% CI, 0.437-0.618; P < .0001) and non-STEMI (aOR = 0.489; 95% CI, 0.364-0.656; P < .0001) compared with those who were married. There was no association between marriage status and in-hospital outcomes.
Unmarried patients with STEMI experienced greater risk for long-term all-cause mortality (aHR = 1.225; 95% CI, 1.031-1.456; P = .0209) and major adverse cardiac and cerebrovascular events (aHR = 1.277; 95% CI, 1.089-1.498; P = .0027) compared with married patients. Findings were similar for patients with non-STEMI (aHR for long-term all-cause mortality = 1.302; 95% CI, 1.036-1.638; P = .0239; aHR for major adverse cardiac and cerebrovascular events = 1.368; 95% CI, 1.105-1.694; P = .004).
“Although marital status does not independently contribute to the disparity in in-hospital mortality between married and unmarried groups, our study shows a clear and consistent protective effect of marriage in the long-term follow-up after acute MI,” the researchers wrote. “Unmarried patients represent an at-risk population lacking social and emotional support and displaying a high risk of major depression. Patients who lack emotional support do poorly after being diagnosed with cardiovascular diseases, mainly mediated by depression. Moreover, spouses of married patients may supervise medication or promote medical advice seeking, which may also account for the protective effect.”
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