Journal Articles

Implementation of a Regional Network for ST‐Segment–Elevation Myocardial Infarction (STEMI) Care and 30‐Day Mortality in a Low‐ to Middle‐Income City in Brazil: Findings From Salvador’s STEMI Registry (RESISST)

July 12, 2018

Nivaldo Menezes Filgueiras Filho, Gilson Soares Feitosa Filho, Davi Jorge Fontoura Solla, Felipe Coelho Argôlo, Patrícia Oliveira Guimarães, Ivan de Mattos Paiva Filho, Larissa Gordilho Mutti Carvalho, Larissa Silva Teixeira, Marcos Nogueira de Oliveira Rios, Sergio Figueiredo Câmara, Victor Oliveira Novais, Leonardo de Souza Barbosa, Constance Silva Ballalai, Carolina Vitoria De Lúcia, Christopher B. Granger, L. Kristin Newby, Renato D. Lopes. Implementation of a Regional Network for ST‐Segment–Elevation Myocardial Infarction (STEMI) Care and 30‐Day Mortality in a Low‐ to Middle‐Income City in Brazil: Findings From Salvador’s STEMI Registry (RESISST). Journal of the American Heart Association. 2018;7:e008624. Originally published July 6, 2018

Author Affiliations

Universidade Federal do Estado de São Paulo, São Paulo, BrazilUniversidade do Estado da Bahia, Salvador, Bahia, BrazilUniversidade Salvador – rede Laureate, Salvador, Bahia, Brazil

Escola Bahiana de Medicina e Saúde Pública, SalvadorBahiaBrazil

Serviço de Atendimento Móvel de Urgência – SAMU 192, SalvadorBrazil

Duke Clinical Research Institute, Duke University School of MedicineDurhamNC

Universidade Salvador – rede Laureate, SalvadorBahiaBrazil

Duke Clinical Research Institute, Duke University School of MedicineDurhamNC

Abstract

Background 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.

Methods and Results 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 STEMInetwork 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% (P<0.001) and 60.4% to 79.7% (P<0.001), respectively. Rates of primary reperfusion also increased (29.1%–53.8%; P<0.001), and more patients were transferred to the referral center (44.7%–76.3%; P=0.001). Thirty‐day mortality rates decreased from 19.8% to 5.1% (P<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.

Conclusions Implementation of a regional STEMI system was associated with lower mortality and higher use of evidence‐based therapies.

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