Perfil clínico e manejo de pacientes com Infarto Agudo do Miocárdio Com Supradesnivelamento do Segmento ST (IAMCSST) no maior hospital de emergência do Amazonas: uma coorte prospectiva

Abstract

Introduction: Timely and effective management of ST-segment elevation myocardial infarction (STEMI) is essential to reduce mortality and complications. In regions with limited infrastructure, delays in access to appropriate therapy can compromise clinical outcomes. This study aimed to analyze the time from diagnosis to therapeutic intervention in STEMI patients admitted to the main public emergency hospital in Amazonas, and to investigate the association between these variables and hospital and 3-month mortality. We hypothesized that treatment delays are associated with worse outcomes. Method: his prospective cohort study was approved by the Ethics Committee (CAAE: 6939823.9.0000.5020, No. 6.732.492). We included consecutive patients with recent STEMI admitted at the main public emergency hospital in Amazonas between April 2024 and December 2024. Clinical, demographic, and therapeutic data were collected, as well as functional capacity at 3 months post-discharge. Analyses included descriptive statistics, Kaplan-Meier survival curves, logistic regression for in-hospital complications, and Cox regression to explore factors associated with mortality. Odds ratios (OR) and 95% confidence intervals (95% CI) were reported, with a significance level of 5%. Analyses were performed using STATA v.14. Results: The sample consisted of 99 patients, with a mean age of 62.9 ± 12.5 years, predominantly male, and self-declared brown. The main comorbidities were arterial hypertension (71.7%) and diabetes (42.4%). At admission, 70.7% were in Killip class 1. The mean time to catheterization was 10 days. No patient underwent primary Percutaneous Coronary Intervention (PCI), and fibrinolytic therapy was performed in 55.6% of cases. In-hospital mortality was 27.3%, and overall mortality within 3 months reached 30,3%. The use of fibrinolysis and a lower degree of clinical impairment were associated with better survival. Conclusion: This pioneering study at the largest public emergency hospital in Amazonas revealed critical delays in reperfusion therapy for patients with STEMI, reflected in high mortality rates and in-hospital complications. Despite the association between fibrinolysis and a lower incidence of complications, restricted access to primary PCI and delays in treatment significantly compromised the clinical and functional prognosis of these patients. The findings highlight the urgent need to implement structured regional cardiovascular care networks with efficient care protocols, expanding access to timely reperfusion therapy and promoting early rehabilitation.