Resultados da intervenção coronária percutânea primária em pacientes do sistema único de saúde e da saúde suplementar

Abstract

Background: Primary percutaneous coronary intervention (PCI) is the most effective reperfusion technique in acute myocardial infarction (AMI) and its success rate depends on many factors. This study aimed to assess the profile and to compare in-hospital outcomes of primary PCI among patients from the Public Healthcare System (PuHS) versus those from the Private Healthcare System (PrHS). Methods: From 2006 to 2010, 493 patients were submitted to primary PCI, of which 220 were treated by the PuHS and 273 by the PrHS. Procedure technique and materials were left to the operator's discretion. Results: The PuHS group had a larger number of Killip > 1 patients. Multivessel coronary disease, pre-procedure coronary flow TIMI 0/1 and the presence of collaterals for the treated vessel did not differ between groups. The PrHS group used more thromboaspiration catheters (10% vs. 20.8%; P < 0.01) and glycoprotein IIb/IIIa inhibitors (24.1% vs. 36.6%; P < 0.01). There was no difference for door-to-balloon times (62.3 minutes vs. 64.2 minutes; P = 0.91). For patients referred from other hospitals, however, transport times were higher for PuHS patients (400.8 minutes vs. 262.4 minutes; P < 0.01). PCI success rates and the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) did not differ between groups (6.3% vs. 6.2%; P = 0.1). Age, Killip III/IV and transport time were the variables that best explai- ned the occurrence of MACCE. Conclusions: Differences in the clinical, angiographic and procedure profile of patients un- dergoing primary PCI treated by the PuHS and the PrHS did not have an impact on MACCE. Transport times, however, high in both groups and higher in the PuHS group, proved to be an independent predictor of adverse events. © 2011 Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista.