Acesso a terapias de reperfusão e mortalidade hospitalar de pacientes com IAMCSST admitidos com insuficiência cardíaca – registro victim

Abstract

Background: Access to reperfusion therapies in proper time is well-recognized as a factor associated with lower mortality in Acute Myocardial Infarction (AMI). Ideally, patients with acute heart failure, an important gravity factor, should have optimized access to reperfusion therapies. Objective: This study aims to evaluate the access to reperfusion therapies and hospital outcomes, with focus on mortality, in patients with acute heart failure complicating ST Segment Elevation Myocardial Infarction admitted on hospitals with percutaneous coronary intervention (PCI) in the state of Sergipe. Methods: Cross-sectional quantitative study, using data from Victim registry. Data were collected from December 2014 to March 2018. Patients were divided in 2 groups, according to the presence of heart failure signs in hospital admission: (1) No heart failure signs (Killip 1) and (2) heart failure signs (Killip > 1). Results: From the 1071 patients, 918 were on Killip class 1 and 153 on Killip class > 1. When compared to patients with Killip class 1, those on Killip class > 1 had lower access to primary angioplasty (52,9% vs. 37,9%; p = 0,001) and higher percentage of patients who only received drug therapy (19,9% vs. 32,0%; p = 0,001). There were no differences in the use of fibrinolitics (2,1% vs. 3,3%; p = 0,354). Mortality was higher beyond patients with signs of heart failure (6,9% vs. 27,0%; p < 0,001). Conclusion: We observed that patients with heart failure signs present a big delay on the arrival to the hospital with angioplasty centre. They also have lower access to reperfusion therapies, with significative difference in the access to primary angioplasty. A big percentage of these patients receive only drug therapy. The low access to these therapies is one of the factors that contribute to higher mortality in this group of patients.