Int J Angiol 2023; 32(03): 179-187
DOI: 10.1055/s-0043-1767697
Original Article

Comparisons of Patients Living Alone versus Living with Others in Acute Coronary Syndrome

Yusaku Shibata
1   Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
2   Cardiovascular Center, Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
Akihiro Shirakabe
1   Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
Yasushi Miyauchi
2   Cardiovascular Center, Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
Kuniya Asai
1   Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
› Author Affiliations


We aimed to examine the relationship of living arrangements (i.e., living alone or living with others) with background, clinical severity, preintervention culprit lesion plaque morphology, and clinical outcomes in patients with acute coronary syndrome (ACS).

Among 1,683 consecutive patients with ACS, we retrospectively compared patients living alone (n = 318) versus living with others (n = 1,362). Optical coherence tomography (OCT) findings, which are high-resolution intracoronary imaging devices, were analyzed in patients with preintervention OCT and compared between patients living alone (n = 174) versus those living with others (n = 665).

Older (median; 69 vs. 67 y, p = 0.046) and female (31 vs. 17%, p < 0.001) patients more frequently lived alone. Frequency of achieving a time interval of 6 hours or less from ACS onset to admission was lower in patients living alone (56 vs. 63%, p = 0.022). Clinical presentation was more severe in patients living alone (Killip II/III/IV; 27 vs. 22%, p = 0.029). Plaque morphology evaluated by OCT was similar between groups (plaque rapture; 48 vs. 48%, p = 0.171). Kaplan–Meier analyses revealed higher rates of cardiac mortality during 2-year follow-up period in patients living alone [13.9 vs. 8.5%, hazard ratio (HR) 1.604, 95% confidence interval (CI) 1.112–2.313, p = 0.010]. After traditional cardiovascular risk factors and clinical severity upon admission had been adjusted, living alone was an independent predictor of cardiac mortality in ACS patients (HR 1.582, 95% CI 1.056–2.371, p = 0.026). Living alone was independently associated with 2-year cardiacmortality in ACS patients after adjusting for background and presentation and might be unrelated to the development of atherosclerosis.

Publication History

Article published online:
12 April 2023

© 2023. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Antman EM, Cohen M, Bernink PJ. et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000; 284 (07) 835-842
  • 2 Yeh RW, Secemsky EA, Kereiakes DJ. et al; DAPT Study Investigators. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA 2016; 315 (16) 1735-1749
  • 3 McNamara RL, Kennedy KF, Cohen DJ. et al. Predicting in-hospital mortality in patients with acute myocardial infarction. J Am Coll Cardiol 2016; 68 (06) 626-635
  • 4 Takeuchi M, Ogita M, Wada H. et al. Comparison of long-term mortality between living alone patients vs. living together patients with acute coronary syndrome treated with percutaneous coronary intervention. Eur Heart J Qual Care Clin Outcomes 2020; 6 (04) 332-337
  • 5 Marcus G, Litovchik I, Pereg D. et al. Impact of marital status on the outcome of acute coronary syndrome: results from the acute coronary syndrome Israeli survey. J Am Heart Assoc 2019; 8 (14) e011664
  • 6 Kitamura T, Sakata Y, Nakatani D. et al. Living alone and risk of cardiovascular events following discharge after acute myocardial infarction in Japan. J Cardiol 2013; 62 (04) 257-262
  • 7 Barbash IM, Gaglia Jr MA, Torguson R. et al. Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization. Am Heart J 2013; 166 (04) 729-736
  • 8 Hadi Khafaji HA, Al Habib K, Asaad N. et al. Marital status and outcome of patients presenting with acute coronary syndrome: an observational report. Clin Cardiol 2012; 35 (12) 741-748
  • 9 O'Shea JC, Wilcox RG, Skene AM. et al. Comparison of outcomes of patients with myocardial infarction when living alone versus those not living alone. Am J Cardiol 2002; 90 (12) 1374-1377
  • 10 Udell JA, Steg PG, Scirica BM. et al; REduction of Atherothrombosis for Continued Health (REACH) Registry Investigators. Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis. Arch Intern Med 2012; 172 (14) 1086-1095
  • 11 Bucholz EM, Rathore SS, Gosch K. et al. Effect of living alone on patient outcomes after hospitalization for acute myocardial infarction. Am J Cardiol 2011; 108 (07) 943-948
  • 12 Kubo T, Imanishi T, Takarada S. et al. Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol 2007; 50 (10) 933-939
  • 13 Kobayashi N, Hata N, Tsurumi M. et al. Relation of coronary culprit lesion morphology determined by optical coherence tomography and cardiac outcomes to serum uric acid levels in patients with acute coronary syndrome. Am J Cardiol 2018; 122 (01) 17-25
  • 14 Kobayashi N, Shibata Y, Okazaki H. et al. A novel technique of low molecular weight dextran infusion followed by catheter push (D-PUSH) for optical coherence tomography. EuroIntervention 2021; 17 (02) e149-e151
  • 15 Tearney GJ, Regar E, Akasaka T. et al; International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT). Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 2012; 59 (12) 1058-1072
  • 16 Prati F, Regar E, Mintz GS. et al; Expert's OCT Review Document. Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 2010; 31 (04) 401-415
  • 17 Jia H, Abtahian F, Aguirre AD. et al. In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. J Am Coll Cardiol 2013; 62 (19) 1748-1758
  • 18 Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 2000; 20 (05) 1262-1275
  • 19 Franklin K, Goldberg RJ, Spencer F. et al; GRACE Investigators, The Global Registry of Acute Coronary Events. Implications of diabetes in patients with acute coronary syndromes. Arch Intern Med 2004; 164 (13) 1457-1463
  • 20 Bucholz EM, Strait KM, Dreyer RP. et al. Effect of low perceived social support on health outcomes in young patients with acute myocardial infarction: results from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study. J Am Heart Assoc 2014; 3 (05) e001252
  • 21 Mookadam F, Arthur HM. Social support and its relationship to morbidity and mortality after acute myocardial infarction: systematic overview. Arch Intern Med 2004; 164 (14) 1514-1518
  • 22 Nakatsuma K, Shiomi H, Watanabe H. et al; CREDO-Kyoto AMI Investigators. Comparison of long-term mortality after acute myocardial infarction treated by percutaneous coronary intervention in patients living alone versus not living alone at the time of hospitalization. Am J Cardiol 2014; 114 (04) 522-527
  • 23 Schmaltz HN, Southern D, Ghali WA. et al. Living alone, patient sex and mortality after acute myocardial infarction. J Gen Intern Med 2007; 22 (05) 572-578
  • 24 Kristofferzon ML, Löfmark R, Carlsson M. Myocardial infarction: gender differences in coping and social support. J Adv Nurs 2003; 44 (04) 360-374
  • 25 Joung IM, van de Mheen HD, Stronks K, van Poppel FW, Mackenbach JP. A longitudinal study of health selection in marital transitions. Soc Sci Med 1998; 46 (03) 425-435
  • 26 Kobayashi N, Takano M, Tsurumi M. et al. Features and outcomes of patients with calcified nodules at culprit lesions of acute coronary syndrome: an optical coherence tomography study. Cardiology 2018; 139 (02) 90-100
  • 27 Saia F, Komukai K, Capodanno D. et al; OCTAVIA Investigators. Eroded versus ruptured plaques at the culprit site of STEMI: in vivo pathophysiological features and response to primary PCI. JACC Cardiovasc Imaging 2015; 8 (05) 566-575
  • 28 Niccoli G, Montone RA, Di Vito L. et al. Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome. Eur Heart J 2015; 36 (22) 1377-1384
  • 29 Goldman N, Korenman S, Weinstein R. Marital status and health among the elderly. Soc Sci Med 1995; 40 (12) 1717-1730
  • 30 Molloy GJ, Hamer M, Randall G, Chida Y. Marital status and cardiac rehabilitation attendance: a meta-analysis. Eur J Cardiovasc Prev Rehabil 2008; 15 (05) 557-561
  • 31 DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol 2004; 23 (02) 207-218