Ritt Luiz Eduardo Fonteles, Silva Pedro Gabriel Melo de Barros E, Darzé Eduardo Sahade, Santos Renato Hideo Nakagawa, de Oliveira Queila Borges, Berwanger Otavio, Mattos Luiz Alberto Piva E, Dos Santos Elizabete Silva, Souza Antonio Carlos Sobral, Cavalcante Margaret Assad, de Andrade Pedro Beraldo, Neuenschwander Fernando Carvalho, Vargas Filho Hugo, Guimarães Jorge Ilha, de Andrade Jadelson Pinheiro, de Paola Angelo Amato Vincenzo, Malachias Marcus Vinícius Bolívar, Précoma Dalton Bertolim, Bacal Fernando, Dutra Oscar Pereira
Instituto D'Or de Ensino e Pesquisa, Rio de Janeiro, RJ - Brasil.
Hospital Cárdio Pulmonar, Salvador, BA - Brasil.
Arq Bras Cardiol. 2024 Dec 6;121(11):e20230863. doi: 10.36660/abc.20230863. eCollection 2024.
There is a lack of information from Brazil regarding therapies used and outcomes in patients with acute coronary syndrome with ST elevation (STEMI).
To evaluate evidence-based therapies, occurrence of outcomes, reperfusion use, and predictors of not receiving reperfusion in patients with STEMI in a national multicenter registry.
Patients with STEMI from the ACCEPT registry, with up to 12 hours of symptoms, were followed for 1 year for the occurrence of major adverse cardiovascular events. A significance level of p < 0.05 was applied for all analyses.
In the analysis of 1553 patients, the reperfusion rate was 76.8%, ranging from 47.5% in the North Region to 80.5% in the Southeast Region. The rate of major adverse cardiovascular events was 12.5% at 1 year. The prescription of evidence-based therapies at hospital admission was 65.6%. The presence of hypertension (odds ratio [OR] 1.47; 95% confidence interval [CI] 1.11 to 1.96; p < 0.01); prior acute myocardial infarction (OR 1.81; 95% CI 1.32 to 2.48; p < 0.001); and the North (OR 4.65; 95% CI 2.87 to 7.52; p < 0.001), Central-West (OR 4.02; 95% CI 1.26 to 12.7; p < 0.05), and Northeast Regions (OR 1.70; 95% CI 1.17 to 2.46; p < 0.01) were independent predictors of not receiving reperfusion therapy.
In the 1-year follow-up of the ACCEPT Registry, we were able to verify a wide variation within Brazilian geographical regions regarding adherence to best care practices. The following were independent predictors of not receiving reperfusion therapy: being treated in the North, Central-West, and Northeast Regions; having systemic arterial hypertension; and prior infarction.
巴西缺乏关于ST段抬高型急性冠状动脉综合征（STEMI）患者所采用治疗方法及治疗结果的信息。
在一项全国多中心登记研究中，评估STEMI患者基于证据的治疗方法、治疗结果的发生率、再灌注治疗的使用情况以及未接受再灌注治疗的预测因素。
对来自ACCEPT登记研究的STEMI患者，症状出现时间长达12小时，随访1年以观察主要不良心血管事件的发生情况。所有分析的显著性水平为p < 0.05。
在对1553例患者的分析中，再灌注率为76.8%，范围从北部地区（47.5%）到东南部地区（80.5%）。1年时主要不良心血管事件的发生率为12.5%。入院时基于证据的治疗方法的处方率为65.6%。高血压（比值比[OR] 1.47；95%置信区间[CI] 1.11至1.96；p < 0.01）；既往急性心肌梗死（OR 1.81；95% CI 1.32至2.48；p < 0.001）；以及北部地区（OR 4.65；95% CI 2.87至7.52；p < 0.001）、中西部地区（OR 4.02；95% CI 1.26至12.7；p < ；0.05）和东北部地区（OR 1.70；95% CI 1.17至2.46；p < 0.01）是未接受再灌注治疗的独立预测因素。
在ACCEPT登记研究的1年随访中，我们能够证实巴西不同地理区域在遵循最佳治疗实践方面存在很大差异。以下是未接受再灌注治疗的独立预测因素：在北部、中西部和东北部地区接受治疗；患有系统性动脉高血压；以及既往有心肌梗死病史。
