We have read the study by Escaño-Marín et al.1 with great interest and would like to congratulate the authors on their contribution to defining the relationship between socioeconomic markers and health outcomes. This subject has received insufficient attention in the literature and is, moreover, largely overlooked by cardiologists, despite its profound health policy implications. In their study, the authors show that low regional gross domestic product correlates with elevated cardiovascular mortality and a relatively low primary angioplasty rate. Although the authors do not explicitly assign cause, the article implies that the lower regional mortality in richer autonomous communities is in some way related to a higher rate of primary angioplasty. Independently of their wealth, almost all the Spanish autonomous communities have programs in place for early reperfusion after acute myocardial infarction. Using the data reported in the study, we have analyzed the correlation between the number of primary angioplasty procedures and the geographical area of the autonomous communities (excluding the Balearic and Canary Islands); this analysis reveals that autonomous community size is inversely related to the number of primary angioplasty procedures (Figure). The appropriate quality measure in the treatment of infarction is not primary angioplasty, but appropriate and timely reperfusion (the inapt slogan Stent for life should instead be Reperfusion for life).

Figure.

Correlation between the number of primary angioplasty procedures and the geographical size of Spanish autonomous communities, excluding the Balearic and Canary islands.

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