Rede de infarto com supradesnivelamento de ST: sistematização em 500 casos diminui eventos clínicos na rede pública

• Ano de defesa: 2016
• Autor(a) principal: Caluza, Ana Christina Vellozo [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: myocardial infarction; guidelines; emergencies; quality of health care; infarto do miocárdio; diretrizes; qualidade de assistência a saúde
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3682988; https://repositorio.unifesp.br/handle/11600/47336

Background: The major cause of deaths in the city of Sao Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15-20% due to difficulties inherent in large metropoles. Objectives: To describe in-hospital mortality in ST Elevation acute myocardial infarction (STEMI) of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network). Methods: Health care teams of seven emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé, Saboya, João XXIII, Pirituba, Público municipal) of the periphery of the São Paulo and advanced ambulances of Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU) were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis) or in to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni and multivariate analysis. Results: From November 2009 to November consecutive patients used the STEMI network, and the findings were as follows: anterior wall infarctions, 37 complete atrioventricular blocks, 41 cases occurring cardiogenic shock PCR, 2 cases of hemorrhagic stroke and intra-hospital mortality was 6,5% (33 cases). There was no difference in mortality relation to initial reperfusion (PCIxFI), both in-hospital (>0,05) and late (p=0,566). Late mortality was 8 % and adverse events were 10.7% of angina, 4.1% reinfarction, 1.4% and 0.5 % of stroke. The late ejection fraction was higher in cases of FI (p = 0.023). Conclusions: The organization in a public health system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer and a tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.