Gabriela Borrayo-Sánchez1, Martín Rosas-Peralta2, Erick Ramírez-Arias3, Guillermo Saturno-Chiu3, Joel Estrada-Gallegos3, Rodolfo Parra-Michel4, Hugo R Hernandez-García4, Ernesto A Ayala-López5, Rafael Barraza-Felix5, Andrés García-Rincón5, Débora Adalid-Arellano5, Guillermo Careaga-Reyna6, José L Lázaro-Castillo6, Lidia E Betancourt-Hernández7, Rocío Camacho-Casillas8, Martha Hernández-Gonzalez9, Germán Celis-Quintal9, Beatriz Villegas-González10, Marco Hernández-Carrillo11, Zaria M Benitez Arechiga11, Abelardo Flores-Morales3, Ana C Sepúlveda-Vildosola12. 1. Programa "A Todo Corazón", Centro Médico, Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México. Electronic address: gborrayos@yahoo.com.mx. 2. Programa "A Todo Corazón", Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México. 3. Hospital de Cardiología, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico. 4. Hospital de Especialidades, Centro Medico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico. 5. Hospital de Especialidades, Centro Medico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico. 6. Hospital General, Centro Medico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico. 7. Hospital de Especialidades Veracruz, Instituto Mexicano del Seguro Social, Veracruz, Mexico. 8. Hospital de Especialidades Coahuila, Instituto Mexicano del Seguro Social, Coahuila, Mexico. 9. Hospital de Especialidades Guanajuato, Instituto Mexicano del Seguro Social, Guanajuato, Mexico. 10. Hospital de Especialidades Puebla, Instituto Mexicano del Seguro Social, Puebla, Mexico. 11. Hospital de Especialidades Sonora, Instituto Mexicano del Seguro Social, Sonora, México. 12. Unidad de Investigación y Educación en Salud Política, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Abstract
INTRODUCTION: Mexico is the country with the highest mortality due to acute myocardial infarction in adults older than 45 years old according to the OECD (28 vs. 7.5% of the average). The first real-world study, RENASCA IMSS, showed a high-risk population at 65%, but 50% without reperfusion strategies. The aim was to describe the clinical presentation, treatment, and outcomes of acute coronary syndromes at the IMSS. METHODS: RENASCA IMSS is a nation-wide, prospective, longitudinal-cohort study. We include consecutive patients with an Acute Coronary Syndrome diagnosis (ACC/AHA/ESC) admitted in 177 representative hospitals of the IMSS (166 of second level and 11 of third level of attention). In an electronic database clinical, paraclinical, times, reperfusion treatment, complications, and other variables were assessed. Confidentiality was maintained in data and informed consent was obtained. Registrer calibration was performed with more than 80% of the variables and 80% of the cases. RESULTS: From March 1, 2014 to December 25, 2017; 21,827 patients were enrolled presenting an average age 63.2 ± 11.7, 75% men (16,259) and 25% women (5,568). The most frequent risk factors were: hypertension (60.5%), smoking (46.8%), diabetes (45.5%), dyslipidemia (35.3%) and metabolic syndrome (39.1%). STEMI diagnosis was established in 73.2% of the patients and NSTEMI in 26.8%. The STEMI group within the Code Infarction showed an improvement in the reperfusion therapy (34.9% before vs. 71.4% after, p ≤0.0001) and reduction of mortality (21.1 vs. 9.4%, p ≤0.0001); while the NSTEMI group showed high risk set by a GRACE score of 131.5 ± 43.7 vs. 135.9 + 41.7, p ≤0.0001. Mortality was more frequent within the STEMI group (14.9 vs. 7.6%, p ≤0.0001). CONCLUSIONS: RENASCA IMSS study represents the largest Acute Coronary Syndromes real-world study in Mexico, demonstrating that the Mexican population has a high risk. Patients with a STEMI diagnosis were more frequently enrolled and were associated with higher mortality and complications; however, there is improvement in the reperfusion therapy and in mortality with the Code Infarction strategy.
INTRODUCTION: Mexico is the country with the highest mortality due to acute myocardial infarction in adults older than 45 years old according to the OECD (28 vs. 7.5% of the average). The first real-world study, RENASCA IMSS, showed a high-risk population at 65%, but 50% without reperfusion strategies. The aim was to describe the clinical presentation, treatment, and outcomes of acute coronary syndromes at the IMSS. METHODS: RENASCA IMSS is a nation-wide, prospective, longitudinal-cohort study. We include consecutive patients with an Acute Coronary Syndrome diagnosis (ACC/AHA/ESC) admitted in 177 representative hospitals of the IMSS (166 of second level and 11 of third level of attention). In an electronic database clinical, paraclinical, times, reperfusion treatment, complications, and other variables were assessed. Confidentiality was maintained in data and informed consent was obtained. Registrer calibration was performed with more than 80% of the variables and 80% of the cases. RESULTS: From March 1, 2014 to December 25, 2017; 21,827 patients were enrolled presenting an average age 63.2 ± 11.7, 75% men (16,259) and 25% women (5,568). The most frequent risk factors were: hypertension (60.5%), smoking (46.8%), diabetes (45.5%), dyslipidemia (35.3%) and metabolic syndrome (39.1%). STEMI diagnosis was established in 73.2% of the patients and NSTEMI in 26.8%. The STEMI group within the Code Infarction showed an improvement in the reperfusion therapy (34.9% before vs. 71.4% after, p ≤0.0001) and reduction of mortality (21.1 vs. 9.4%, p ≤0.0001); while the NSTEMI group showed high risk set by a GRACE score of 131.5 ± 43.7 vs. 135.9 + 41.7, p ≤0.0001. Mortality was more frequent within the STEMI group (14.9 vs. 7.6%, p ≤0.0001). CONCLUSIONS: RENASCA IMSS study represents the largest Acute Coronary Syndromes real-world study in Mexico, demonstrating that the Mexican population has a high risk. Patients with a STEMI diagnosis were more frequently enrolled and were associated with higher mortality and complications; however, there is improvement in the reperfusion therapy and in mortality with the Code Infarction strategy.