Abstract 10858: Comparison of Clinical Effect of Living Alone Between Urban Area and Rural Area in Patient with Acute Coronary Syndrome

Background and Objective: Living alone is reported as an independent risk factor for worse clinical outcomes after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Manifestations of psychological stress in patients living alone is reported to be associated with subsequent cardiovascular events. The impact of living alone on the psychological factors of patients may be differ depending on their living environment. However, comparison of the effects of living alone in different living environment on the prognosis of patients with ACS has not been reported. Purpose: The aim of the study was to compare the effect of living alone on clinical outcomes in patients with ACS between urban and rural area. Methods: Data from a multi-center, observational study of consecutive ACS patients who underwent emergency PCI between January 2012 and December 2016 were analyzed. The clinical endpoint was major adverse cardiovascular events (MACE) which defined as composite of cardiovascular death, ACS, and stroke. Results: In this study, 1349 patients were enrolled and divided into two population according to their living environment; urban area (n=417), and rural area (n=932). 87 patients (20.9 %) in urban area, and 169 patients (18.1 %) in rural were living alone. There were no significant differences in baseline characteristics between the living alone and the living together group in both urban and rural area. During a median follow-up period of 2.1 years, Kaplan-Meier curves showed the living alone group had higher risk of MACE than the living together group in urban area (log-rank, p=0.01). On the other hands, no significant differences were shown in the incidences of MACE between two groups in rural area (p=0.86). After adjustment for other covariates, the living alone was significantly associated with MACE (hazard ratio [HR], 2.83; 95 % confidential interval [CI], 1.16-6.91; p=0.02) compared with the living together in urban area. However, in rural area, the living alone group was not significantly associated with MACE (HR, 1.02; 95 % CI, 0.66-1.57; p=0.92) compared with the living together group. Conclusion: Living alone was significantly associated with worse clinical outcomes after emergency PCI of ACS in urban area but not in rural area.