Ciro Pollio Benvenuto

AimsTo comprehensively evaluate the impact of socioeconomic status on in-hospital mortality in NSTEMI. MethodsThis study included all patients hospitalized in Belgium between 2012 and 2021 with NSTEMI. In-hospital mortality, procedures, and relevant clinical variables were recorded. Socioeconomic factors included neighborhood-level income and education, residential population density and residential greenness, sex, marital status, occupational category, and personal income. ResultsThe study population consisted of 64890 subjects, 33,3% females, median age 73 years. 50,4% of patients underwent PCI, while 8,8% underwent CABG. In-hospital mortality was 5,0%. Neighborhood-level income was significantly associated with in-hospital mortality (OR 0,83, p<0,01). When stratified by neighborhood income quartiles, patients in the lowest quartile had a higher risk compared to those in the highest quartile (OR 1,48, p<0,01). Residential population density slightly increased NSTEMI mortality (OR 1,01, p<0,01), whereas greenness decreased NSTEMI mortality (OR 0,94, p=0,02). At the individual level, marital status was significantly associated with the outcome, with single status showing the strongest association (OR 1,42, p<0,01). Female sex and unemployment were not significantly associated with the outcome (p=0,25, and p=0,71, respectively), whereas personal income decreased in-hospital mortality (OR 0.67, p<0,01). No sex specific difference was observed. ConclusionIn this large nationwide study, both decreased of neighborhood and individual incomes were associated with NSTEMI in-hospital mortality. These findings highlight the importance of integrating social determinants of health, as financial precarity, into cardiovascular risk assessment to reduce disparities in care and outcomes.

Acute and Chronic Coronary Syndromes represent two major medical challenges and are the leading cause of cardiovascular mortality and morbidity. While Chronic Coronary Syndrome (CCS) can be defined as the whole group of structural and/or functional abnormalities involving coronary arteries before and after an acute event, Acute Coronary Syndrome (ACS) encompasses the condition of acute myocardial ischemia (with or without consequent myocardial injury and troponin release) due to dynamic mechanisms such as athero-thrombosis or vasospasm. Because of this complex interplay between structural and functional mechanisms arising from both the epicardial and microvascular compartments, a comprehensive approach to fully investigate the whole spectrum of coronary disease is therefore essential. To address this issue, the invasive functional assessment has evolved through the years, from a way to guide revascularization to a meticulous protocol for characterizing ischemia-leading mechanisms and stratifying prognosis both in ACS and CCS. However, coronary physiology remains underused in clinical practice, and multiple gaps in knowledge still exist; on top of this, there is increasing heterogeneity regarding how to perform functional assessment, with different protocols proposed by various centers. The aim of this review is to summarize the evidence in the field of coronary physiology, and to discuss how and when to use it at its best.