Universidade Estadual de Campinas (Unicamp) - Departamento de Cardiologia, Campinas, SP - Brasil.
Universidade de Brasília, Brasília, DF - Brasil.
Arq Bras Cardiol. 2024 May 13;121(5):e20230650. doi: 10.36660/abc.20230650. eCollection 2024.
Early reperfusion therapy is acknowledged as the most effective approach for reducing case fatality rates in patients with ST-segment elevation myocardial infarction (STEMI).
Estimate the clinical and economic consequences of delaying reperfusion in patients with STEMI.
This retrospective cohort study evaluated mortality rates and the total expenses incurred by delaying reperfusion therapy among 2622 individuals with STEMI. Costs of in-hospital care and lost productivity due to death or disability were estimated from the perspective of the Brazilian Unified Health System indexed in international dollars (Int$) adjusted by purchase power parity. A p < 0.05 was considered statistically significant.
Each additional hour of delay in reperfusion therapy was associated with a 6.2% increase (95% CI: 0.3% to 11.8%, p = 0.032) in the risk of in-hospital mortality. The overall expenses were 45% higher among individuals who received treatment after 9 hours compared to those who were treated within the first 3 hours, primarily driven by in-hospital costs (p = 0.005). A multivariate linear regression model indicated that for every 3-hour delay in thrombolysis, there was an increase in in-hospital costs of Int$497 ± 286 (p = 0.003).
The findings of our study offer further evidence that emphasizes the crucial role of prompt reperfusion therapy in saving lives and preserving public health resources. These results underscore the urgent need for implementing a network to manage STEMI cases.
早期再灌注治疗被认为是降低 ST 段抬高型心肌梗死（STEMI）患者病死率的最有效方法。
评估 STEMI 患者再灌注延迟的临床和经济后果。
本回顾性队列研究评估了 2622 例 STEMI 患者再灌注治疗延迟的死亡率和总费用。从巴西统一卫生系统的角度，根据购买力平价调整国际元（Int$）计算住院治疗费用和因死亡或残疾导致的生产力损失。p<0.05 被认为具有统计学意义。
再灌注治疗每延迟 1 小时，住院期间死亡风险增加 6.2%（95%CI：0.3%~11.8%，p=0.032）。与前 3 小时内接受治疗的患者相比，9 小时后接受治疗的患者总体费用增加 45%，主要是由于住院费用增加（p=0.005）。多变量线性回归模型表明，溶栓每延迟 3 小时，住院费用增加 Int$497±286（p=0.003）。
本研究结果进一步证明了及时再灌注治疗在挽救生命和保护公共卫生资源方面的重要作用。这些结果强调了迫切需要建立一个网络来管理 STEMI 病例。
