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.
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: Gabriel Dotta; Francisco Antonio Helfenstein Fonseca; Maria Cristina de Oliveira Izar; Marco Tulio de Souza; Flavio Tocci Moreira; Luiz Fernando Muniz Pinheiro; Adriano Henrique Pereira Barbosa; Adriano Mendes Caixeta; Rui Manoel Santos Póvoa; Antônio Carlos Carvalho; Henrique Tria Bianco Journal: Arq Bras Cardiol Date: 2018-12-17 Impact factor: 2.000
Authors: Ticiane Clair Remacre Munareto Lima; Danielle Góes da Silva; Ikaro Daniel de Carvalho Barreto; Jussiely Cunha Oliveira; Laís Costa Souza Oliveira; Larissa Andreline Maia Arcelino; Jeferson Cunha Oliveira; Antônio Carlos Sobral Sousa; José Augusto Soares Barreto Filho Journal: Arq Bras Cardiol Date: 2019-07-18 Impact factor: 2.000
Authors: Pedro Ivo M Moraes; Claudia Rodrigues Alves; Marco Tulio Souza; Suzi Emiko Kawakami; Iran Goncalves; Adriano Henrique Pereira Barbosa; Antonio Celio Moreno; Adriano Mendes Caixeta; Antonio Carlos Carvalho Journal: Open Heart Date: 2019-07-29
Authors: Felipe José de Andrade Falcão; Cláudia Maria Rodrigues Alves; Adriano Henrique Pereira Barbosa; Adriano Caixeta; José Marconi Almeida Sousa; José Augusto Marcondes Souza; Amaury Amaral; Luiz Carlos Wilke; Fátima Cristina A Perez; Iran Gonçalves Júnior; Edson Stefanini; Antônio Carlos Carvalho Journal: Clinics (Sao Paulo) Date: 2013-12 Impact factor: 2.365
Authors: Ricardo Wang; Fernando Carvalho Neuenschwander; Augusto Lima Filho; Celsa Maria Moreira; Elizabete Silva dos Santos; Helder Jose Lima Reis; Edson Renato Romano; Luiz Alberto Piva e Mattos; Otávio Berwanger; Jadelson Pinheiro de Andrade Journal: Arq Bras Cardiol Date: 2014-02-17 Impact factor: 2.000
Authors: Pedro Beraldo de Andrade; Mônica Vieira Athanazio de Andrade; Robson Alves Barbosa; André Labrunie; Mauro Esteves Hernandes; Roberto Luiz Marino; Dalton Bertolim Precoma; Francisco Carleial Feijó de Sá; Otávio Berwanger; Luiz Alberto Piva e Mattos Journal: Arq Bras Cardiol Date: 2014-05-27 Impact factor: 2.000