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)
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...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.008624 |
| _version_ | 1811332408257019904 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Nivaldo Menezes Filgueiras Filho |
| collection | DOAJ |
| description | 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 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% (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. |
| first_indexed | 2024-04-13T16:35:26Z |
| format | Article |
| id | doaj.art-b2ea04a6c3a5474fb5284608ad817269 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:35:26Z |
| publishDate | 2018-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-b2ea04a6c3a5474fb5284608ad8172692022-12-22T02:39:26ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-07-0171410.1161/JAHA.118.008624Implementation 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)Nivaldo Menezes Filgueiras Filho0Gilson Soares Feitosa Filho1Davi Jorge Fontoura Solla2Felipe Coelho Argôlo3Patrícia Oliveira Guimarães4Ivan de Mattos Paiva Filho5Larissa Gordilho Mutti Carvalho6Larissa Silva Teixeira7Marcos Nogueira de Oliveira Rios8Sergio Figueiredo Câmara9Victor Oliveira Novais10Leonardo de Souza Barbosa11Constance Silva Ballalai12Carolina Vitoria De Lúcia13Christopher B. Granger14L. Kristin Newby15Renato D. Lopes16Universidade Federal do Estado de São Paulo São Paulo BrazilEscola Bahiana de Medicina e Saúde Pública Salvador Bahia BrazilServiço de Atendimento Móvel de Urgência – SAMU 192 Salvador BrazilServiço de Atendimento Móvel de Urgência – SAMU 192 Salvador BrazilDuke Clinical Research Institute Duke University School of Medicine Durham NCServiço de Atendimento Móvel de Urgência – SAMU 192 Salvador BrazilServiço de Atendimento Móvel de Urgência – SAMU 192 Salvador BrazilServiço de Atendimento Móvel de Urgência – SAMU 192 Salvador BrazilServiço de Atendimento Móvel de Urgência – SAMU 192 Salvador BrazilServiço de Atendimento Móvel de Urgência – SAMU 192 Salvador BrazilServiço de Atendimento Móvel de Urgência – SAMU 192 Salvador BrazilServiço de Atendimento Móvel de Urgência – SAMU 192 Salvador BrazilUniversidade Salvador – rede Laureate Salvador Bahia BrazilUniversidade Salvador – rede Laureate Salvador Bahia BrazilDuke Clinical Research Institute Duke University School of Medicine Durham NCDuke Clinical Research Institute Duke University School of Medicine Durham NCDuke Clinical Research Institute Duke University School of Medicine Durham NCBackground 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 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% (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.https://www.ahajournals.org/doi/10.1161/JAHA.118.008624Brazilmortalityregional careregistryST‐segment–elevation myocardial infarction |
| spellingShingle | 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: Cardiovascular and Cerebrovascular Disease Brazil mortality regional care registry ST‐segment–elevation myocardial infarction |
| title | 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) |
| title_full | 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) |
| title_fullStr | 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) |
| title_full_unstemmed | 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) |
| title_short | 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) |
| title_sort | 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 |
| topic | Brazil mortality regional care registry ST‐segment–elevation myocardial infarction |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.008624 |
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