Document Detail


ST-Elevation myocardial infarction network: systematization in 205 cases reduced clinical events in the public health care system.
MedLine Citation:
PMID:  23138668     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The major cause of death in the city of São Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15% and 20% due to difficulties inherent in large metropoles.
OBJECTIVE: To describe in-hospital mortality in ST-segment 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 four emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé and Saboya) of the periphery of the city of São Paulo and advanced ambulances of the 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 6 to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni- and multivariate analysis.
RESULTS: From January 2010 to June 2011, 205 consecutive patients used the STEMI Network, and the findings were as follows: 87 anterior wall infarctions; 11 left bundle-branch blocks; 14 complete atrioventricular blocks; and 14 resuscitations after initial cardiorespiratory arrest. In-hospital mortality was 6.8% (14 patients), most of which due to cardiogenic shock, one hemorrhagic cerebrovascular accident, and one bleeding.
CONCLUSION: The organization in the public health care system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer, and tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.
Authors:
Ana Christina Vellozo Caluza; Adriano H Barbosa; Iran Gonçalves; Carlos Alexandre L de Oliveira; Lívia Nascimento de Matos; Claus Zeefried; Antonio Célio C Moreno; Elcio Tarkieltaub; Cláudia Maria R Alves; Antonio Carlos Carvalho
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Publication Detail:
Type:  Journal Article     Date:  2012-11-09
Journal Detail:
Title:  Arquivos brasileiros de cardiologia     Volume:  99     ISSN:  1678-4170     ISO Abbreviation:  Arq. Bras. Cardiol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-27     Completed Date:  2013-05-20     Revised Date:  2013-09-04    
Medline Journal Info:
Nlm Unique ID:  0421031     Medline TA:  Arq Bras Cardiol     Country:  Brazil    
Other Details:
Languages:  eng; por     Pagination:  1040-8     Citation Subset:  IM    
Affiliation:
Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil. acvcaluza@cardiol.br
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Ambulances
Brazil
Emergency Medical Services / statistics & numerical data
Epidemiologic Methods
Female
Hospital Mortality*
Humans
Male
Middle Aged
Myocardial Infarction / mortality*
National Health Programs / organization & administration,  statistics & numerical data*
Pilot Projects
Time Factors
Comments/Corrections
Comment In:
Arq Bras Cardiol. 2013 May;100(5):486-7   [PMID:  23888492 ]
Arq Bras Cardiol. 2013 May;100(5):485   [PMID:  23740434 ]
Arq Bras Cardiol. 2013 Jun;100(6):584
Arq Bras Cardiol. 2013 Jun;100(6):583-4   [PMID:  23842876 ]

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