Tempo de atraso para intervenção coronariana percutânea primária em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST atendidos inicialmente em hospitais primário com e sem tele eletrocardiografia ( TELE ECG)

Abstract

INTRODUCTION: As it is the most severe form of acute coronary syndrome, rapid detection by means of tele electrocardiography (TELE-ECG) and other tests, and referral of patients withacute myocardial infarction with ST-segment elevation (STEMI) for care in referral hospitals in cardiac reperfusion plays a fundamental role in the survival of the individual. GOAL: To analyze the difference in the total time of care of patients with STEMI initially treated in health centers with and without tele-ECG, and referred to a regional referral hospital in interventional cardiology in the city of Arapongas, Paraná, Brazil, for primary Percutaneous Coronary Intervention.METHODS: Observational, cross-sectional and retrospective study, based on medical records of patients with STEMIwho were treated in health centers in Paraná and later transferred to areference center in interventional cardiology. For the geolocation data of the municipalities (with tele-ECG and without tele-ECG) that referred patients to this cardiology referral center in Arapongas, Paraná, Brazil, the QGIS software version 3.16 was used.The statistical comparisons oftime to reperfusion procedure (first medical contact until balloon inflation) in patients seen at health centers with and without TELE-ECGwere performed using the Shapiro-Wilk test of the computer program RStudio version 4.1.0 (R Core Team, 2021) to assess normality. Since, in both groups, the data were not normally distributed (p≤0.05), the Mann-Whitney was used to assess whether there was a statistical difference between the groups, adopting a significance level of 5% (p ≤0.05).RESULTS: We analyzed 76 data from patients diagnosed with STEMI and transferred via the Mobile Emergency Care Service (SAMU) from 46 municipalities in the state of Paraná. The median time between the first medical visit and balloon inflation was five hours and 25 minutes for patients treated in health centers with TELE-ECG and four hours and 32 minutes for those treated in places without TELE-ECG, showing differences significant among them (p<0.05). CONCLUSION:The time between the first medical consultation and balloon inflation was significantly shorter in patients treated at health centers without TELE-ECG, indicating that it is likely that these places, because they do not perform this test, trigger the SAMU more quickly, speeding up the process of transferring patients to the reference centers in cardiac reperfusion. Despite this, further studies on the effects of TELE-ECG in patients with STEMI should be carried out to better understand the factors associated with delay in transfer between health centers and the impacts of delay in care in these patients, to improve accessibility. to referral hospitals and increase the survival of patients.