Sociodemographic and clinical variables as determinants of mortality and survival in patients with acute ST-elevation myocardial infarction in the Eastern Amazon.

Background: The aim of this study was to analyze the influence of sociodemographic and clinical variables as determinants of mortality and survival in patients with ST-segment elevation acute myocardial infarction in the Eastern Amazon. Design and methods: This observational, longitudinal, and retrospective study was conducted at the Gaspar Vianna Clinical Hospital Foundation in patients hospitalized from January 2017 to June 2020. Patients were divided into two groups: those who survived (G1) (n = 646) and those who died (G2) (n = 37). Sociodemographic and clinical variables associated with mortality and survival in these two groups were analyzed. Results: Patients with STEMI who had the highest risk of death were often the oldest (G1: 61.58 ± 10.74 years; G2: 69.57 ± 9.02 years; t = -4.492; p = 0.001), with Killip III-IV classifications (OR = 0.13; 95% CI = 0.02-0.71; p = 0.03), and with diseases such as heart failure (OR = 0.07; 95% CI = 0.004-1.50; p = 0.168) or renal failure (OR = 0.03; 95% CI = 0.006-0.16; p = 0.0001). In addition, female sex (hazard ratio = 2.073; 95% CI = 1.413-5.170), Killip III-IV classifications (hazard ratio = 4.041; 95% CI = 1.703-18.883) and the presence of heart failure (hazard ratio = 34.102; 95% CI = 4.410-263.684) or renal failure (hazard ratio = 14.278; 95% CI = 3.275-62.248) shortened in-hospital survival. Conclusions: Specific sociodemographic and clinical aspects influenced mortality and survival in patients with acute ST -elevation myocardial infarction.

Door-to-balloon Time in Cardiovascular Emergency Care in a Hospital of Northern Brazil

Abstract Background The use of an adequate door-to-balloon time (≤ 90 minutes) is crucial in improving the quality of care provided to patients with ST-segment elevation myocardial infarction (STEMI). Objective To determine the door-to-balloon time in the management of STEMI patients in a cardiovascular emergency department in a hospital of northern Brazil. Methods This was a cross-sectional study based on review of medical records. A total of 109 patients with STEMI admitted to the emergency department of a referral cardiology hospital in Pará State, Brazil, between May 2017 and December 2017. Correlations of the door-to-balloon time with length of hospital stay and mortality rate were assessed, as well as whether the time components of the door-to-balloon time affected the delay in performing primary percutaneous coronary intervention. Quantitative variables were analyzed by Spearman correlation and the G test was used for categorical variables. A p<0.05 was set as statistically significant. Results Median door-to-balloon time was 104 minutes. No significant correlation was found between door-to-balloon time and length of hospital stay or deaths, but significant correlations were found between door-to-balloon time and door-to-ECG time (p<0.001) and ECG-to-activation (of an interventional cardiologist) time (p<0.001). Conclusion The door-to-balloon time was longer the recommended and was not correlated with the length of hospital stay or in-hospital mortality. Door-to-ECG time and ECG-to-activation time contributed to the delay in performing the primary percutaneous coronary intervention. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Avaliação do tempo porta-balão como um indicador da qualidade assistencial / Assessment of door-to-balloon time as an indicator of quality care

Objetivo: avaliar o tempo porta-balão após a implantação de um protocolo de atendimento no Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST. Método: trata-se de um estudo quantitativo, descritivo, observacional, retrospectivo, obtendo-se os dados por meio de prontuários disponibilizados pelo Serviço de Apoio Médico Estatístico e pela Emergência Cardiológica, organizando-os cronologicamente, em cinco grupos, com 44 prontuários, como indicador da qualidade assistencial e, em seguida, analisando-os a partir da estatística de medidas de média e desvio-padrão. Resultados: avaliaram-se 220 prontuários. Identificou-se redução do tempo porta-balão, de 121 ± 56 minutos no primeiro grupo para 100 ± 33 minutos, comparado ao segundo; posteriormente, constatou-se progressivo aumento, sendo 112 ± 40 minutos no terceiro, 126 ± 46 minutos no quarto e 123 ± 36 minutos no último grupo. Conclusão: constatou-se que, após a implantação do protocolo, houve a diminuição do tempo porta-balão em curto prazo, inferindo-se, assim, a possibilidade de menor desempenho na qualidade assistencial.(AU)

Objective: to evaluate the door-to-balloon time after the implantation of a care protocol in Acute Myocardial Infarction with ST-segment elevation. Method: this is a quantitative, descriptive, observational, retrospective study, obtaining data through medical records made available by the Statistical Medical Support Service and by the Cardiac Emergency, organizing them chronologically, in five groups, with 44 medical records, as an indicator of quality of care and then analyzing them from the statistics of measures of mean and standard deviation. Results: 220 medical records were evaluated. A reduction in door-to-balloon time was identified, from 121 ± 56 minutes in the first group to 100 ± 33 minutes, compared to the second; subsequently, there was a progressive increase, with 112 ± 40 minutes in the third, 126 ± 46 minutes in the fourth and 123 ± 36 minutes in the last group. Conclusion: it was found that, after the implementation of the protocol, there was a shortening of the door-to-balloon time in the short term, thus inferring the possibility of lower performance in care quality.(AU)

Objetivo: evaluar el tiempo puerta-balón, después de la implementación de un protocolo de atención en el Infarto Agudo de Miocardio con Elevación del Segmento ST. Método: este es un estudio cuantitativo, descriptivo, observacional, retrospectivo, que obtiene datos a través de registros médicos puestos a disposición por el Servicio Estadístico de Apoyo Médico y por la Emergencia Cardíaca, organizándolos cronológicamente, en cinco grupos, con 44 registros médicos, como indicador de la calidad de la atención, luego analizándolos a partir de las estadísticas de medidas de desviación media y estándar. Resultados: se evaluaron 220 registros médicos. Se identificó una reducción en el tiempo de puerta-balón, de 121 ± 56 minutos en el primer grupo a 100 ± 33 minutos, en comparación con el segundo, posteriormente, se encontró un aumento progresivo, con 112 ± 40 minutos en el tercero, 126 ± 46 minutos en el cuarto y 123 ± 36 minutos en el último grupo. Conclusión: se encontró que después de la implementación del protocolo, hubo una disminución del tiempo puerta-balón a corto plazo, lo que infiere la posibilidad de un menor rendimiento en la calidad de la atención.(AU)