Following an acute myocardial infarction, patients with lower education are less likely to receive coronary angiography and subsequent PCI, according to Enxhela Sulo‘s PhD thesis. The less educated also are at increased risk of out-of-hospital coronary death.


  1. Both short-term and longer-term survival following acute myocardial infarction in Norway improved every year between 2001 and 2009.
  2. Coronary angiography was given more often to patients with higher education than to patients with only basic education.
  3. The risk of dying from acute coronary artery disease out of hospital was markedly higher in patients with lower education.


Thesis: Coronary heart disease care and outcomes in Norway; time trends and socioeconomic inequalities
Candidate: Enxhela Sulo
Time: September 27, 2017 at 12:15
Place: Main Building, Haukeland University Hospital: Large Auditorium
Link to university website (in Norwegian)


(1) Between 2001 and 2009, there was one hospitalization for first acute myocardial infarction at a Norwegian hospital every 41 minutes. Mortality at one month declined by 3.8 % each year throughout the period, and also all-cause mortality after one year decreased in both men and women in all age groups.

The studies of Sulo use data from the Cardiovascular Disease in Norway Project (CVDNOR), and include more than 115 000 patients hospitalized for myocardial infarction. About one fourth of the patients died within a year of hospitalization.

(2) 11 % of the patients had higher education, whereas about half of them only had primary education. There was a steady increase in the amount of patients receiving revascularisation throughout the period in all education groups. However, patients with higher education were more likely to recieve PCI than patients with lower education. This difference was due to educational differences in receiving coronary angiography. The difference decreased over time, but was still present in 2009.

(3) The incidence rate for deaths from coronary heart disease occurring outside the hospital in Norway decreased by almost 60 % from 1995 to 2009. Individuals with tertiary education had far lower risk than individuals with only basic education, og these educational differences did not change over time. The study includes 60 000 out-of-hospital coronary deaths.


(1) Sulo, E., Vollset, S. E., Nygård, O., Sulo, G., Igland, J., Egeland, G. M., Ebbing, M., & Tell, G. S. (2015). Trends in 28‐day and 1‐year mortality rates in patients hospitalized for a first acute myocardial infarction in Norway during 2001–2009: a “Cardiovascular disease in Norway”(CVDNOR) projectJournal of internal medicine277(3), 353-361.

(2) Sulo, E., Nygård, O., Vollset, S. E., Igland, J., Sulo, G., Ebbing, M., Egeland, G. M., Hawkins, N. M., & Tell, G. S. (2016). Coronary angiography and myocardial revascularization following the first acute myocardial infarction in Norway during 2001–2009: Analyzing time trends and educational inequalities using data from the CVDNOR projectInternational journal of cardiology212, 122-128.

(3) Sulo, E., Nygård, O., Vollset, S. E., Igland, J., Ebbing, M., Østbye, T., Jørgensen, T., Sulo, G., & Tell, G. S. (2017). Time Trends and Educational Inequalities in Out‐of‐Hospital Coronary Deaths in Norway 1995–2009: A Cardiovascular Disease in Norway (CVDNOR) ProjectJournal of the American Heart Association6(2), e005236.

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