Mortalidade Hospitalar Por Infarto do Miocárdio na América Latina e no Caribe: Revisão Sistemática e Metanálise

Abstract

Background: Most cardiovascular deaths occur in low-and middle-income countries and myocardial infarction is one of the main life-threatening conditions. Objective: We assessed all-cause in-hospital mortality in patients admitted for myocardial infarction (STEMI and NSTEMI) in Latin America and the Caribbean from 2000 onward. Methods: We systematically searched in electronic bibliographic databases for cohort studies which reported in-hospital mortality due to STEMI and NSTEMI. A meta-analysis was performed and a p-value < 0.05 was considered significant. Results: We identified 38 studies (29 STEMI, 3 NSTEMI and 6 both). Pooled STEMI in-hospital mortality was 9.9% (95% CI: 9.1 – 10.7). Heterogeneity was not trivial (I2 = 74% and prediction interval = 6.6 – 14.5). The percentage of reperfusion therapy and decade explain part of the heterogeneity (I2 = 54%). The higher the rate of reperfusion therapy, the lower the in-hospital mortality (coefficient =-0.009, 95% CI:-0.013 to-0.006, p<0.001). This mortality was higher in the first decade as compared with the second (coefficient =-0.14, 95% CI:-0.27 to-0.02, p=0.047). Pooled NSTEMI in-hospital mortality was 6.3% (95% CI: 5.4 – 7.4) and heterogeneity was null. Conclusion: Pooled STEMI in-hospital mortality in low-and middle-income countries was high in comparison with rates reported in high income countries. To improve these estimates, higher use of reperfusion therapy must be pursued. Pooled NSTEMI in-hospital mortality was similar to the ones found in high-income countries; however, it was based on few studies and most of them were carried out in two countries.