RESUMEN
BACKGROUND: Few data exist on regional systems of care for the treatment of ST-segment-elevation myocardial infarction (STEMI) in developing countries. Our objective was to describe temporal trends in 30-day mortality and identify predictors of mortality among STEMI patients enrolled in a prospective registry in Brazil. METHODS AND RESULTS: From January 2011 to June 2013, 520 patients who received initial STEMI care at 23 nonspecialized public health units or hospitals, some of whom were transferred to a public cardiology referral center, were identified through a regional STEMI network supported by telemedicine and the local prehospital emergency medical service. We stratified patients into five 6-month periods based on presentation date. Mean age (±SD) of patients was 62.0 (±12.2) years, and 55.6% were men. The mean Global Registry of Acute Coronary Events (GRACE) score was 145 (±34). Overall mortality at 30 days was 15.0%. Use of dual antiplatelet therapy and statins increased significantly from baseline (January 2011) to period 5 (June 2013): 61.8% to 93.6% (P<0.001) and 60.4% to 79.7% (P<0.001), respectively. Rates of primary reperfusion also increased (29.1%-53.8%; P<0.001), and more patients were transferred to the referral center (44.7%-76.3%; P=0.001). Thirty-day mortality rates decreased from 19.8% to 5.1% (P<0.001). In multivariable analysis, factors independently associated with 30-day mortality were higher GRACE score, history of previous stroke, lack of transfer to the referral center, and lack of use of optimized medical therapy. CONCLUSIONS: Implementation of a regional STEMI system was associated with lower mortality and higher use of evidence-based therapies.
Asunto(s)
Mortalidad/tendencias , Transferencia de Pacientes/tendencias , Programas Médicos Regionales , Infarto del Miocardio con Elevación del ST/terapia , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Aspirina/uso terapéutico , Brasil , Cardiología , Servicios Médicos de Urgencia , Femenino , Adhesión a Directriz , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/tendencias , Inhibidores de Agregación Plaquetaria/uso terapéutico , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Antagonistas del Receptor Purinérgico P2Y/uso terapéutico , Sistema de Registros , Telemedicina , Centros de Atención TerciariaRESUMEN
OBJECTIVE: to assess the impact of the shift inlet trauma patients, who underwent surgery, in-hospital mortality. METHODS: a retrospective observational cohort study from November 2011 to March 2012, with data collected through electronic medical records. The following variables were statistically analyzed: age, gender, city of origin, marital status, admission to the risk classification (based on the Manchester Protocol), degree of contamination, time / admission round, admission day and hospital outcome. RESULTS: during the study period, 563 patients injured victims underwent surgery, with a mean age of 35.5 years (± 20.7), 422 (75%) were male, with 276 (49.9%) received in the night shift and 205 (36.4%) on weekends. Patients admitted at night and on weekends had higher mortality [19 (6.9%) vs. 6 (2.2%), p=0.014, and 11 (5.4%) vs. 14 (3.9%), p=0.014, respectively]. In the multivariate analysis, independent predictors of mortality were the night admission (OR 3.15), the red risk classification (OR 4.87), and age (OR 1.17). CONCLUSION: the admission of night shift and weekend patients was associated with more severe and presented higher mortality rate. Admission to the night shift was an independent factor of surgical mortality in trauma patients, along with the red risk classification and age.
Asunto(s)
Mortalidad Hospitalaria , Admisión del Paciente/estadística & datos numéricos , Heridas y Lesiones/mortalidad , Adulto , Sesgo , Estudios de Cohortes , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Factores de TiempoRESUMEN
ABSTRACTObjective:to assess the impact of the shift inlet trauma patients, who underwent surgery, in-hospital mortality.Methods:a retrospective observational cohort study from November 2011 to March 2012, with data collected through electronic medical records. The following variables were statistically analyzed: age, gender, city of origin, marital status, admission to the risk classification (based on the Manchester Protocol), degree of contamination, time / admission round, admission day and hospital outcome.Results:during the study period, 563 patients injured victims underwent surgery, with a mean age of 35.5 years (± 20.7), 422 (75%) were male, with 276 (49.9%) received in the night shift and 205 (36.4%) on weekends. Patients admitted at night and on weekends had higher mortality [19 (6.9%) vs. 6 (2.2%), p=0.014, and 11 (5.4%) vs. 14 (3.9%), p=0.014, respectively]. In the multivariate analysis, independent predictors of mortality were the night admission (OR 3.15), the red risk classification (OR 4.87), and age (OR 1.17).Conclusion:the admission of night shift and weekend patients was associated with more severe and presented higher mortality rate. Admission to the night shift was an independent factor of surgical mortality in trauma patients, along with the red risk classification and age.
RESUMOObjetivo:verificar o impacto do turno de admissão de pacientes vítimas de trauma, submetidos ao tratamento cirúrgico, na mortalidade hospitalar.Métodos:estudo de coorte observacional retrospectivo no período de novembro de 2011 a março de 2012, com dados coletados através de prontuário eletrônico. Foram analisadas estatisticamente as variáveis de interesse: idade, sexo, cidade de origem, estado civil, classificação de risco à admissão (baseado no Protocolo de Manchester), grau de contaminação, horário/turno de admissão, dia de admissão e desfecho hospitalar.Resultados: Quinhentos e sessenta e três pacientes traumatizados foram submetidos ao tratamento cirúrgico no período estudado, com média de idade de 35,5 anos (± 20,7), sendo 75% do sexo masculino, 49,9% admitidos no turno noturno e 36,4% aos finais de semana. Os pacientes admitidos à noite e aos finais de semana apresentaram maior mortalidade, 6,9% vs. 2,2%, p=0,014, e 5,4% vs. 3,9%, p=0,014, respectivamente. À análise multivariada, os fatores preditores independentes de mortalidade foram a admissão noturna (OR 3,15), a classificação de risco vermelho (OR 4,87), e a idade (OR 1,17).Conclusão:a admissão no turno noturno e no final de semana foi associada com pacientes de maior gravidade e apresentaram maior taxa de mortalidade. A admissão no turno noturno foi fator independente de mortalidade em pacientes traumatizados cirúrgicos, juntamente com a classificação de risco vermelho e a idade.