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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1381504

Advancements in Reperfusion Rates and Quality of Care for ST-Segment Elevation Myocardial Infarction: A Ten-Year Evaluation of Salvador's STEMI Network

Provisionally accepted
Polliana d. Roriz Polliana d. Roriz 1*Isabella B. Ferreira Isabella B. Ferreira 2Fabiana B. Pontes Fabiana B. Pontes 3Antônio Fernando Machado Antônio Fernando Machado 4Tercio Aguiar Tercio Aguiar 4Marcos Almeida Matos Marcos Almeida Matos 2Ivan d. Paiva Filho Ivan d. Paiva Filho 1Rodrigo C. de Menezes Rodrigo C. de Menezes 5Bruno B. Andrade Bruno B. Andrade 6*
  • 1 Servico de Atendimento Movel de Urgencia (SAMU), Protocolo IAM, Salvador, Brazil
  • 2 Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
  • 3 Hospital Ana Nery, Salvador, Bahia, Brazil
  • 4 Salvador University, Salvador, Bahia, Brazil
  • 5 Instituto de Pesquisa Clínica e Translacional, Faculdade ZARNS, Salvador, Brazil
  • 6 Gonçalo Moniz Institute (IGM), Salvador, Bahia, Brazil

The final, formatted version of the article will be published soon.

    Background: Continuous investment and systematic evaluation of program accomplishments are required to achieve excellence in ST-segment elevation myocardial infarction (STEMI) care, especially in resourcelimited settings. Therefore, this study evaluates the impact of problem-driven interventions on reperfusion use rate in a long-term operating STEMI network from a low-to middle-income country. Methods: This is a healthcare improvement evaluation study of Salvador's public STEMI network in a quasi-experimental design, comparing data from 2009-2010 (pre-intervention) and 2019-2020 (post-intervention). There were evaluated all confirmed STEMI cases assisted in both periods. The interventions, implemented since 2017, included: expanding the support team, defining criteria to be a spoke, and initiating continuous education activities. The primary outcome was the rate of patients undergoing reperfusion, with secondary outcomes being time from door-to-ECG (D2E) and ECG-to-STEMI-team trigger (E2T). Results: Over ten years, the network's coverage increased by 300,000 individuals, and expanded by 1,800 km 2 . A total of 885 records were analyzed, 287 in the pre-intervention group (182 men [63•4%]; mean [SD] age 62•1 [12•5] years) and 598 in the postintervention group (356 men [59•5%]; mean [SD] age 61.9 [11•8] years). It was noticed a substantial increase in reperfusion delivery rate (90 [31%] vs. 431 [73%]; P=•001) and reductions in time from D2E (159 [83-340] vs. 29 , P=•001), and E2T (31 [21-44] vs. 16 [6-40], P=•001). Conclusion: The strategies adopted by Salvador's STEMI network were associated with significant improvements in the rate of patients undergoing reperfusion and in D2E and E2T. However, the mortality rate remains high.

    Keywords: ST-elevation myocardial infarction, Reperfusion, Universal health care, Developing Countries, Quality Improvement

    Received: 03 Feb 2024; Accepted: 11 Jul 2024.

    Copyright: © 2024 Roriz, Ferreira, Pontes, Machado, Aguiar, Matos, Paiva Filho, de Menezes and Andrade. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Polliana d. Roriz, Servico de Atendimento Movel de Urgencia (SAMU), Protocolo IAM, Salvador, Brazil
    Bruno B. Andrade, Gonçalo Moniz Institute (IGM), Salvador, Bahia, Brazil

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