ABC | Volume 111, Nº4, Octuber 2018

Short Editorial Arq Bras Cardiol. 2018; 111(4):594-595 Oliveira Prehospital phase in STEMI 1. Villela PB, Klein CH, Oliveira GMM. Evolução daMortalidade por Doenças Cerebrovasculares e Hipertensivas no Brasil entre 1980 e 2012. Arq Bras Cardiol. 2016; 107(1):26-32. 2. Piegas LS, Timerman A, Feitosa GS, Nicolau JC, Mattos LAP, Andrade MD, et al., Sociedade Brasileira de Cardiologia. V Diretriz sobre tratamento do infarto agudo do miocardio com supradesnivel do segmento ST. Arq Bras Cardiol. 2015; 105(2):1-105. 3. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. ESC Scientific Document Group; 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST- segment elevation: The Task Force for themanagement of acutemyocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2):119-77. 4. Nascimento BR, Brant LCC, Oliveira GMM, Malachias MVB, Reis GMA, Teixeira RA, et al. Cardiovascular disease epidemiology in portuguese- speaking countries: data from the Global Burden of Disease, 1990 to 2016. Arq Bras Cardiol. 2018; 110(6):500-11. 5. Sederholm LS, Isaksson RM, Ericsson M, Ängerud K, Thylén I, On behalf of the SymTime Study Group. Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study. BMJ Open. 2018;8(5): e020211. 6. Nguyen HL, Saczynski JS, Gore JM, Goldberg RJ. Age and sex differences in duration of pre-hospital delay in patients with acute myocardial infarction: a systematic review. Circ Cardiovasc Qual Outcomes. 2010;3(1):82-92. 7. RiveroF, Bastante T, Cuesta J, Benedicto A, Salamanca J, Restrepo J, et al. Factors associated with delays in seeking medical attention in patients with ST-segment elevation acute coronary syndrome. Rev Esp Cardiol. 2016; 69(3):279-85. 8. Abreu D, Cabral MS, Ribeiro F. Factors associated with longer delays in reperfusion in ST-segment elevation myocardial infarction. Int J Cardiol Heart Vessel. 2014;4:97-101. 9. Rodrigues JA, Melleu K, Schmidt MM, Gottschall CAM, Moraes MAP, Quadros AS. Independent predictors of late presentation in patients with st-segment elevation myocardial infarction. Arq Bras Cardiol. 2018; 111(4):587-593. 10. Bugiardini R, Ricci B, Cenko E, Vasiljevic Z, Kedev S, Davidovic G, et al. Delayed care and mortality among women and men with myocardial infarction. J AmHeart Assoc. 2017;6(8):e005968. 11. Yonemoto N, Kada A, Yokoyama H, Hiroshi N. Public awareness of the need to call emergency medical services following the onset of acute myocardial infarctionandassociatedfactors inJapan.JIntMedRes.2018;46(5):1747-55. References This is an open-access article distributed under the terms of the Creative Commons Attribution License mortality was even higher in those who arrived at the hospital with more than twelve hours’ delay, as they did not receive any form of reperfusion therapy. In the study carried out by Rodrigues et al., these patients were excluded, thus making it impossible to establish a comparison. 9 Cultural differences regarding attitudes toward AMI symptoms are also relevant patient-dependent factors. A recent study carried out in Japan showed that patients who were men, were elderly, had lower levels of schooling and had lower self‑confidence regarding their understanding of AMI would present delays in seeking medical treatment. 11 These patient‑related factors were also absent from Rodrigues et al. 9 It is important to highlight that the results of the study carried out by Rodrigues et al. come from a single center whose conditions are quite rare in Brazil, which demonstrates that the continuous availability of mechanical reperfusion therapy was not sufficient to reduce the 30-day AMI mortality rate of about 10% in patients who arrived at the hospital with more than six hours’ delay following onset of symptoms. This is an additional conclusion to the data presented by the authors. It is necessary to invest not only in the availability of excellent mechanical reperfusion therapy, but also in equal access to healthcare systems, both by improving the population’s socio-economic and cultural conditions and by implementing thrombolytic therapy close to the place where the patient is located during the onset of symptoms or in pre-hospital transport. Only then will we be able to make the mortality rates we observe in our clinical practice match the ones described in the clinical trials of the guidelines. 595