The Impact of Marital Status on the Outcome of Acute Coronary Syndrome (from the Acute Coronary Syndrome Israeli Survey)

Background: Marriage is one of the common forms of social support. Conflicting evidence exists regarding the impact of marital status on the outcomes of acute coronary syndrome (ACS) patients. It is further not clear if gender disparity exists in the outcome of married and non-married (NM) ACS patients.

Methods: Data from the ACS Israeli Survey (ACSIS) collected between 2004 and 2016 was utilized to compare baseline characteristics, clinical indices, and outcomes of married and NM ACS patient. Cox regression analysis and propensity score matching were used to explore if marital status was independently associated with long-term outcome.

Results: Out of 7,233 patients included with reported marital status, 5,643 (78%) were married. Married patients were younger (62.69±12.07 vs. 68.47±14.84 years; p<0.001), more frequently males (83.1% vs. 54.8%; p<0.001) and less likely to be hypertensive (61.1% vs. 69.3%; p<0.001). All-cause mortality incidence at 30-days and at 1-year was lower in married patients (3.1% vs. 7.6%; p<0.001; 7.1% vs. 15.3%; p<0.001, respectively). After adjusting for multiple covariates, the hazard ratio for 5-year all-cause mortality for married patients was 0.74 (95%CI; 0.62-0.88). Similar results were observed after propensity score matching. Kaplan Meier estimates for all-cause mortality at 5 years demonstrated the best prognosis for married men, and the worst for NM women.

Conclusions: Marriage is independently associated with better short and long-term outcomes across the spectrum of ACS. Attempts to intensify secondary prevention measures should focus on NM patients and especially NM women.