ABC | Volume 112, Nº5, May 2019

Original Article Disparities In The Use Of Drug-eluting Stents For Diabetic Patients With ST-elevation Acute Myocardial Infarction Assisted In the Public versus Private Network - VICTIM Register Jussiely Cunha Oliveira, 1, 2 L aís Costa Souza Oliveira, 1, 3 Jeferson Cunha Oliveira, 1, 3 Ikaro Daniel de Carvalho Barreto, 4 Marcos Antonio Almeida-Santos, 5 Ticiane Clair Remacre Munareto Lima , 1 L arissa Andreline Maia Arcelino, 1, 6 Isadora Soares Bispo Santos Silva, 7 A ntônio Carlos Sobral Sousa, 1,7,8, 9 J osé Augusto Soares Barreto-Filho 1,7,8, 9 Núcleo de Pós-graduação em Ciências da Saúde da Universidade Federal de Sergipe, 1 Aracaju, SE – Brazil Universidade Tiradentes, 2 Aracaju, SE – Brazil Hospital Primavera, 3 Aracaju, SE – Brazil Núcleo de Pós-graduação em biometria e estatística aplicada da Universidade Federal Rural de Pernambuco, 4 Recife, PE – Brazil Programa de Pós-graduação em Saúde e Ambiente da Universidade Tiradentes, 5 Aracaju, SE – Brazil Faculdade Estácio de Sá, 6 Aracaju, SE – Brazil Departamento de Medicina da Universidade Federal de Sergipe, 7 Aracaju, SE – Brazil Centro de Ensino e Pesquisa da Fundação São Lucas, 8 Aracaju, SE – Brazil Divisão de Cardiologia do Hospital Universitário da Universidade Federal de Sergipe, 9 Aracaju, SE – Brazil Mailing Address: José Augusto Soares Barreto-Filho • Av. Gonçalo Prado Rollemberg, 211, sala 202 - Centro de Saúde Prof. José Augusto Barreto. Postal Code 49010-410, São José, Aracaju, SE – Brazil E-mail: jasbf@cardiol.br , joseaugusto.se@gmail.com Manuscript received March 11, 2018, revised manuscript August 07, 2018, accepted October 02, 2018 DOI: 10.5935/abc.20190054 Abstract Background: Primary angioplasty (PA) with placement of either bare metal or drug-eluting stents (DES) represents the main strategy in the treatment of ST-elevation myocardial infarction (STEMI). Diabetic patients, however, represent a special population in STEMI, with high rates of restenosis and unfavorable clinical outcomes, and with the use of DES, level of evidence A and indication class II, being indicated to reduce these damages. Objectives: To evaluate the DES rate of use in patients with STEMI and in the subgroup of diabetics assisted in the public versus private health network in Sergipe. Methods: This is a population-based, cross-sectional study with a quantitative approach using the data from the VICTIM Register. These were collected in the only four hospitals with capacity to perform PA in Sergipe, from December 2014 to March 2017. Results: A total of 707 patients diagnosed with STEMI were evaluated, of which 589 were attended at SUS and 118 at the private network. The use of DES in PA was lower in SUS compared to the private network in both the total sample (10.5% vs 82.4%, p<0.001) and in subgroup diabetic patients (8.7% vs 90.6%, p < 0.001), respectively. In all hypotheses tested, the level of significance was 5% (p < 0.05). Conclusions: The study reveals a disparity in the use of DES during the performance of PA between the public and private network, both in the total sample and the subgroup for diabetics, with lower rates for SUS users, demonstrating the challenges that need to be overcome in order to achieve quality improvements of the services provided. (Arq Bras Cardiol. 2019; 112(5):564-570) Keywords: ST Elevation Myocardial Infarction; Drug-Eluting; Diabetes Mellitus; Case-Control Studies; Angioplasty; Hospitals,Private; Hospitals, Public. Introduction The early use of coronary reperfusion therapies is one of the main factors associated with the longer survival of patients with acute ST-segment elevation myocardial infarction (STEMI). In this context, primary angioplasty (PA) is the preferred option for this purpose, if started up to 90 minutes after confirmation of the diagnosis of infarction. 1,2 Coronary stent implantation is considered the device of choice for the completion of angioplasty because its use reduces the rates of acute vessel occlusion, and the need for late surgical revascularization when compared to the procedure performed with balloon alone. 3 However, diabetic patients diagnosed with STEMI represent a special population because of the greater difficulty of percutaneous treatment. 4 This group shows high rates of restenosis and is associated with unfavorable clinical outcomes, even with the use of bare metal stents. 1,5 Thus, the Brazilian Society of Hemodynamics and Interventional Cardiology (SBHCI) recommends the preferential use of the 564