Long-Term Outcomes of Roma Population After Invasive Treatment of Acute Myocardial Infarction in Croatia

Background: Clinical and treatment characteristics, and outcomes of Roma patients with acute myocardial infarction (AMI) have not been appropriately investigated. Methods: We retrospectively analyzed 67 Roma patients and 251 non-Roma patients with AMI in one hospital center in Croatia in a period from 2011 to 2015, and followed-up for a median of 84 months. Results: Roma patients had significantly more unfavorable risk factors at admission, more complex coronary artery disease measured by Syntax score, and lower left ventricular ejection fraction at discharge. There were no differences in rates of revascularization after index coronary angiography. Roma patients had significantly worse therapy adherence at last follow-up. Death and composite major adverse cardiac event (MACE) were not significantly more frequent in Roma patients compared to non-Roma (HR 1.11, 95% CI 0.63-1.93 for death, and HR 1.19, 95% CI 0.83-1.70 for MACE). More Roma patients experienced stroke and repeated myocardial infarction during follow-up (10% vs 4.5%, and 15% vs 10%, respectively) but that difference was not significant. Lower left ventricular ejection fraction was independently associated with mortality and MACE within whole cohort. Multivariate regression model for MACE among patients that had reliable data on therapy adherence showed significant independent impact of low therapy adherence. Conclusion: Roma patients with AMI in Croatia have significantly more unfavorable risk profile at admission and worse medical therapy adherence after discharge, but receive appropriate revascularization and experience no excess mortality during long-term follow-up. Their MACE rates could be improved with better patient education and stronger therapy adherence monitoring.