Impacto en la mortalidad tras la implantación de una red de atención al infarto agudo de miocardio con elevación del segmento STestudio IPHENAMIC

Abstract

Introduction and objectives: Very little is known about the impact that ST-segment Elevation Acute Myocardial Infarction (STEMI) care networks have on the population. The objective of this study was to find out if the Galician Acute Myocardial Infarction Care Program (PROGALIAM) in the northern area of Galicia, improved prognosis and achieved equity not only in terms of access to the best reperfusion strategies but also in terms of survival. Methods: All the events coded in the Minimum Basic Data Set (MBDS) as STEMI between 2001 and 2013 in the hospitals of the northern area of PROGALIAM were collected. A total of 6,783 patients were identified and divided into two groups based on the period in which they suffered the event: pre-PROGALIAM (2001-2005); 2,878 patients and PROGALIAM (2006-2013); 3,905 patients. Results: In the Pre-PROGALIAM stage, adjusted mortality at 30 days, 12 months and 5 years was higher in the global population HR: 1.52 - 95% CI (1.31 - 1.77), p < 0.001; HR: 1.48 - 95% CI (1.31 - 1.69), p < 0.001; HR: 1.22 - 95% CI (1.14 - 1.29), p < 0.001, respectively. A significant increase in mortality adjusted to 30 days, 12 months and 5 years was also observed in each of the areas before the implementation of the network. The figures for the A Coruña area were HR: 1.27 - 95% CI (1.01 - 1.60), p = 0.0045; HR: 1.30 - 95% CI (1.07 - 1.58), p = 0.009; HR: 1.12 - 95% CI (1.02 - 1.23), p = 0.02, respectively. For the Lugo area: HR: 1.94 - 95% CI (1.49 - 2.51), p < 0.001; 1.66 - 95% CI (1.34 - 2.07), p < 0.001; 1.34 - 95% CI (1.2 - 1.49), p < 0.001, respectively. And for the Ferrol area: HR: 1.58 - 95% CI (1.1 - 2.24), p = 0.001); HR: 1.64 - 95% CI (1.23 - 2.19), p = 0.001); HR: 1.23 - 95% CI (1.10 - 1.40), p = 0.001), respectively. Before the implementation of PROGALIAM, mortality at 30 days, 12 months and 5 years was higher in the Lugo areas: HR: 1.57 - 95% CI (1.26 - 1.96), p = 0.001; HR: 1.39 - 95% CI (1.40 - 1.68), p = 0.001; HR: 1.25 - 95% CI (1.05 - 1.49), p = 0.02 and Ferrol HR: 1.34 - 95% CI (1.06 - 1.74), p = 0.03 ; HR: 1.39 - 95% CI (1.12 - 1.73), p = 0.03; HR: 1.32 - 95% CI (1.13 - 1.55), p = 0.001, respectively, compared to A Coruña. These differences at 30 days, 12 months and 5 years disappeared after the development of network. The figures for Lugo vs. A Coruña were: HR 1.05; 95% CI (0.85-1.35), p=0.72; HR 1.12; 95% CI (0.91-1.37), p=0.27; HR 0.88; 95% CI (0.72-1.06), p=0.18; and for Ferrol vs. A Coruña: HR 1.10; 95% CI (0.82-1.47), p= 0.53); HR 1.13; 95% CI (0.88-1.43), p=0.33; HR 1.04; 95% CI (0.89-1.22), p=0.58, respectively. Conclusions: The development of PROGALIAM in the northern area of Galicia decreased the short-, medium-, and long-term mortality of patients who suffered STEMI both globally and for each of the areas. Before the implementation of the network, there were fewer chances of survival in the acute phase, in the medium and long term in patients from the areas of Lugo and Ferrol. After its development, there was an increase in equity that equalized the chances of survival in all the time frames studied and for all areas.