Abstract
Introduction: We have shown that implementing a Regional Network in developing countries is feasible. Purpose: Describe temporal trends in 30-Day mortality among STEMI patients enrolled in a prospective registry in Brazil. Methods: From Jan 2011 to Aug 2013, 520 patients received primary STEMI care at 23 non-specialized public health units (7 general hospitals; 16 community-based emergency units) with the option to be transferred to one of two public cardiology reference centers (CRC). These patients were identified through a Regional STEMI Network supported by telemedicine and the local prehospital emergency medical service. Results: Mean age was 62.0 ± 12.2y, and most patients were men (55.6%). Mean GRACE score was 145 ± 34. Overall mortality at 30 days was 15.0%. The median pain-to-admission time was 180 (IQR 66-430) min and admission-to-ECG, 159 (IQR 70-379) min. We analyzed the differences of results over 2.5 year period, separating the patients in 5 6-month periods from 1/2011 to 1/2013. There were no differences in pain-to-admission or admission-to-ECG times and no difference in GRACE score over time. Use of several acute medical treatments increased significantly from baseline to period 5: dual antiplatelet therapy (1/2011, 61.8%; 1/2013, 93.6%; p<0.001) and statin (1/2011, 60.4%; 1/2013, 79.7%; p<0.001). Rates of primary reperfusion also increased (1/2011, 29.1%; 1/2013, 53.8%; p<0.001) and more patients were transferred to CRC (1/2011, 44.7%; 1/2013, 76.3%; p=0.001). 30-day mortality rates decreased from 20.4% in 1/2011 compared with 7.5% in 1/2013 (p<0.001) (Figure). Conclusion: Implementation of a regional STEMI system was associated with lower mortality rates at 30 days and higher use of evidence-based treatment. Our findings highlight opportunities to improve the care of STEMI patients in developing countries.
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