Via Crucis para o Tratamento do Infarto Agudo do Miocárdio : Registro VICTIM

Detalhes bibliográficos
Ano de defesa: 2018
Autor(a) principal: Oliveira, Jussiely Cunha
Orientador(a): Barreto Filho, José Augusto Soares
Banca de defesa: Não Informado pela instituição
Tipo de documento: Tese
Tipo de acesso: Acesso aberto
Idioma: por
Instituição de defesa: Não Informado pela instituição
Programa de Pós-Graduação: Pós-Graduação em Ciências da Saúde
Departamento: Não Informado pela instituição
País: Não Informado pela instituição
Palavras-chave em Português:
Palavras-chave em Inglês:
Área do conhecimento CNPq:
Link de acesso: http://ri.ufs.br/jspui/handle/riufs/8895
Resumo: Introduction: Patients with acute ST-segment elevation myocardial infarction (STEMI) may show differences in clinical outcomes between the sexes, in the comorbidities presented, the rate of myocardial reperfusion use, and the 30-day mortality rate among patients using the Brazilian Universal Health System (SUS) and private network with reasons not yet clear. Objective: To investigate disparities in the quality of care provided to patients with STEMI. Methods: Using the VICTIM Registry database (VIa Crucis for the Treatment of Myocardial Infarction), patients with STEMI, attended at the four hospitals with the capacity to perform primary angioplasty (PA) in the state of Sergipe, were analyzed. The present study investigated risk factors, timing, rates of fibrinolysis and primary PCI use, type of stent used, and the probability of in-hospital mortality and in 30 days in SUS patients compared to those in the private network. Results: A total of 707 patients with STEMI were included, 589 were SUS users and 118 were private users. The time between onset of symptoms and arrival at the hospital with PA was higher for SUS patients compared to the users of the private system (25.4 ± 36.5 h vs. 9.0 ± 21 h; P <0.001 ), respectively. Before arriving at the PCI hospital, rates of fibrinolysis were low in both groups (2.5% vs. 1.7%, P <0.58) respectively. The rates of PA use were also low in both groups, but significantly lower in SUS users (45% vs. 78%, P <0.001). For those who received PCI, the time to reach the hospital with a reference AP was higher for SUS users (7.9 ± 3.7 h vs. 3.8 ± 3.9h; P <0.001). The use of pharmacological stent in primary angioplasty was lower in SUS compared to the private network in both the general population (10.5% vs 82.4%, p <0.001) and in diabetic patients (8.7% vs 90.6% , p <0.001), respectively. Mortality in 30 days occurred in 11.9% of SUS patients and in 5.9% of patients in the private network (p = 0.004). In the complete model, the odds ratio for 30-day mortality for the SUS group was higher (odds ratio, 2.96, 95% CI, 1.15 to 7.61, P = 0.02). Conclusions: The time of arrival at the hospital with PA of SUS users was approximately three times that of patients using the private healthcare system. There was an expressive subgroup of fibrinolytic and PCI in both groups. Disparities were also observed in the use of SF during the performance of PA in both services, both in the general population and for diabetics, with lower rates for SUS users. During the 30-day follow-up, SUS users were significantly more likely to die indicating that there is no equity between the two systems in the treatment of IAMCSST.