Universidade Federal do Estado de São Paulo, São Paulo, Brazil.
Universidade do Estado da Bahia, Salvador, Bahia, Brazil.
J Am Heart Assoc. 2018 Jul 6;7(14):e008624. doi: 10.1161/JAHA.118.008624.
Few data exist on regional systems of care for the treatment of ST-segment-elevation myocardial infarction (STEMI) in developing countries. Our objective was to describe temporal trends in 30-day mortality and identify predictors of mortality among STEMI patients enrolled in a prospective registry in Brazil.
From January 2011 to June 2013, 520 patients who received initial STEMI care at 23 nonspecialized public health units or hospitals, some of whom were transferred to a public cardiology referral center, were identified through a regional STEMI network supported by telemedicine and the local prehospital emergency medical service. We stratified patients into five 6-month periods based on presentation date. Mean age (±SD) of patients was 62.0 (±12.2) years, and 55.6% were men. The mean Global Registry of Acute Coronary Events (GRACE) score was 145 (±34). Overall mortality at 30 days was 15.0%. Use of dual antiplatelet therapy and statins increased significantly from baseline (January 2011) to period 5 (June 2013): 61.8% to 93.6% (<0.001) and 60.4% to 79.7% (<0.001), respectively. Rates of primary reperfusion also increased (29.1%-53.8%; <0.001), and more patients were transferred to the referral center (44.7%-76.3%; =0.001). Thirty-day mortality rates decreased from 19.8% to 5.1% (<0.001). In multivariable analysis, factors independently associated with 30-day mortality were higher GRACE score, history of previous stroke, lack of transfer to the referral center, and lack of use of optimized medical therapy.
Implementation of a regional STEMI system was associated with lower mortality and higher use of evidence-based therapies.
在发展中国家，针对 ST 段抬高型心肌梗死（STEMI）的区域性治疗系统的数据很少。我们的目的是描述巴西一个前瞻性注册研究中 STEMI 患者 30 天死亡率的时间趋势，并确定死亡率的预测因素。
2011 年 1 月至 2013 年 6 月，通过远程医疗和当地院前急救医疗服务支持的区域 STEMI 网络，在 23 个非专科公共卫生单位或医院接受初始 STEMI 治疗的 520 例患者被确定为研究对象，其中一些患者被转诊至公共心脏病学转诊中心。我们根据就诊日期将患者分为五个 6 个月的时间段。患者的平均年龄（±标准差）为 62.0（±12.2）岁，55.6%为男性。平均全球急性冠状动脉事件注册（GRACE）评分 145（±34）。30 天总死亡率为 15.0%。双联抗血小板治疗和他汀类药物的使用率从基线（2011 年 1 月）到第 5 期（2013 年 6 月）显著增加：61.8%升至 93.6%（<0.001）和 60.4%升至 79.7%（<0.001）。直接再灌注治疗的比例也有所增加（29.1%-53.8%；<0.001），更多的患者被转诊至转诊中心（44.7%-76.3%；=0.001）。30 天死亡率从 19.8%降至 5.1%（<0.001）。多变量分析显示，与 30 天死亡率相关的独立因素是较高的 GRACE 评分、既往卒中史、未转至转诊中心和未使用优化的药物治疗。
实施区域 STEMI 系统与降低死亡率和提高循证治疗的使用率相关。
