Marriage & PCI make for a good match

In yet another study that suggests the old ball and chain is a lifeline, a study of marital status and PCI outcomes found married patients had lower in-hospital and one-year mortality rates than unmarried patients.

Some research has pointed to a survival advantage for married patients with acute coronary syndrome. Marriage possibly has a protective effect, offers social support and other resources that facilitate better care or reflects a healthier patient population. Israel M. Barash, MD, of MedStar Washington Hospital in Washington, D.C., and colleagues decided to explore the topic in an observational analysis of 11,216 patients who underwent elective or urgent PCI between 2003 and 2011. The study was published online Sept. 3 in the American Heart Journal.

They divided patients into two groups: married or unmarried, which encompassed patient who were single, divorced or widowed. Their primary outcome was major adverse cardiac events (a composite of death, MI and target lesion revascularization) at one year.

Fifty-five percent of the patients were married. Married patients were more likely to be men, white, have a lower prevalence of coronary artery disease (CAD) risk factors and a higher prevalence of hypercholesterolemia and a family history of CAD.

A larger percentage of unmarried patients had PCI due to MI compared with married patients (16 percent vs. 11 percent) and on average had a longer length of stay in the intensive care unit (0.5 vs. 0.9 days) and hospital length of stay (2.24 vs. 3.5 days).

Unmarried patients’ in-hospital mortality was higher (1.1 percent vs. 0.4 percent) as was their MACE rate at 30 days (3.1 percent vs. 1.2 percent) and at one year (13.3 percent vs. 8.2 percent). The all-cause mortality rate for unmarried patients totaled 8 percent compared with 3.5 percent for married patients.

In a subgroup analysis, Barash et al found marriage conferred benefits to men and women, but the benefits were more pronounced in men.

They observed that unmarried patients had higher rates of comorbidities, which meshes with the theory that healthier people choose marriage more frequently than less healthy people. Married patients also were less likely to stop clopidogrel treatment, which may be due to social support.

“These findings should heighten awareness of physicians for socioeconomic risk factors beyond the standard cardiovascular disease risk factors,” they wrote. As a retrospective, observational study, though, their results may be influenced by unmeasured confounders.