Núcleo de Pós-graduação em Ciências da Saúde da Universidade Federal de Sergipe, Aracaju, SE - Brazil.
Universidade Tiradentes, Aracaju, SE - Brazil.
Arq Bras Cardiol. 2019 May;112(5):564-570. doi: 10.5935/abc.20190054. Epub 2019 Mar 14.
Primary angioplasty (PA) with placement of either bare metal or drug-eluting stents (DES) represents the main strategy in the treatment of ST-elevation myocardial infarction (STEMI). Diabetic patients, however, represent a special population in STEMI, with high rates of restenosis and unfavorable clinical outcomes, and with the use of DES, level of evidence A and indication class II, being indicated to reduce these damages.
To evaluate the DES rate of use in patients with STEMI and in the subgroup of diabetics assisted in the public versus private health network in Sergipe.
This is a population-based, cross-sectional study with a quantitative approach using the data from the VICTIM Register. These were collected in the only four hospitals with capacity to perform PA in Sergipe, from December 2014 to March 2017.
A total of 707 patients diagnosed with STEMI were evaluated, of which 589 were attended at SUS and 118 at the private network. The use of DES in PA was lower in SUS compared to the private network in both the total sample (10.5% vs 82.4%, p<0.001) and in subgroup diabetic patients (8.7% vs 90.6%, p < 0.001), respectively. In all hypotheses tested, the level of significance was 5% (p < 0.05).
The study reveals a disparity in the use of DES during the performance of PA between the public and private network, both in the total sample and the subgroup for diabetics, with lower rates for SUS users, demonstrating the challenges that need to be overcome in order to achieve quality improvements of the services provided.
经皮冠状动脉介入治疗（PA）联合使用裸金属支架或药物洗脱支架（DES）是治疗 ST 段抬高型心肌梗死（STEMI）的主要策略。然而，糖尿病患者是 STEMI 中的一个特殊人群，其再狭窄率和不良临床结局较高，且使用 DES 可降低这些损害，证据水平为 A 级，适应证为 II 类。
评估在巴西塞尔希培州接受公共或私人卫生网络治疗的 STEMI 患者和糖尿病亚组患者中使用 DES 的情况。
这是一项基于人群的横断面研究，采用定量方法，使用 VICTIM 登记处的数据。这些数据于 2014 年 12 月至 2017 年 3 月在塞尔希培州仅有的四家有能力进行 PA 的医院中收集。
共评估了 707 例确诊为 STEMI 的患者，其中 589 例在 SUS 就诊，118 例在私人网络就诊。在总样本中，PA 中使用 DES 的比例在 SUS 明显低于私人网络（10.5%比 82.4%，p<0.001），在糖尿病患者亚组中（8.7%比 90.6%，p < 0.001），这一差异更为显著。在所有假设检验中，显著性水平均为 5%（p < 0.05）。
本研究揭示了在公共和私人网络中，PA 期间 DES 使用存在差异，在总样本和糖尿病亚组中，SUS 使用者的使用率较低，这表明需要克服一些挑战，以实现服务质量的提高。
