O impacto da transferência inter hospitalar para o desfecho em 30 dias do paciente com infarto agudo do miocardio com supradesnivelamento do segmento ST: registro VICTIM

Abstract

Background: In large countries, hospitals that have perform percutaneous coronary intervention (PCI) facility are not always present, and the patient must undergo interhospital transfer (HIT) to perform such treatment. However, HIT should be performed within 12 hours of the onset of symptoms, an ideal time for PCI, in order to avoid worse outcomes in the medium and long term. Objective: To comparatively analyze the time between the onset of symptoms and the arrival at the hospital with PCI and whether there was a significant difference in the 30-day outcomes between patients who had direct access and those who needed HIT to reach the hospital with PCI. Method: This is a study derived from the VICTIM registry in which 878 patients with IAMCSST, between 2014 and 2017, were analyzed in hospitals qualified to perform PCI in Sergipe. Patients were divided into two groups, regarding the form of access to the hospital with PCI, a. Patients with direct access and b. Patients who underwent inter-hospital transfer. Results: Of the 878 patients, 122 obtained direct access to the hospital with PCI and 756 had to undergo interhospital transfer. The time elapsed between onset of symptoms and arrival at the hospital with PCI was 4.7 ± 9.2 hrs vs 24.8 ± 39.9 h (p <0.001), primary PCI was applied in 84.4% vs 45, 6% (p <0.001) and among the outcomes, the main one was the mortality rate with values of 5.7% vs 12.2% (p .037), respectively. Conclusion: With a significant difference in mortality between the groups, with two times worse values among patients with HIT, it is clear that improvements in the HIT times are necessary in order that the patients who need to perform the same have better outcomes in 30 days.