ABC | Volume 112, Nº5, May 2019

Original Article Oliveira et al Stents for diabetic patients – VICTIM Register Arq Bras Cardiol. 2019; 112(5):564-570 drug-eluting stent in diabetics, with evidence level A and indication class II, since these devices release substances that inhibit intimal hyperplasia of the treated vessel, further reducing the chances of restenosis. 1,3 A major obstacle faced with the use of drug-eluting stents (DES) is the high cost of the device when compared to the bare metal one, in addition to the expenses with prolonged double antiplatelet therapy, which further increases its treatment cost. 1,6 However, the cost-effectiveness ratio is attractive for the incorporation of this technology when it comes to diabetic patients, since they reflect a lower budget impact by avoiding late complications and the need for future reinterventions. Thus, this device was released for use in the Brazilian Unified Health System (SUS) for the patients above mentioned in 2014, according to ordinance no. 29 of the Ministry of Health. 7 Therefore, this study aims to evaluate the rate of DES in patients with STEMI, and in the subgroup of diabetic patients assisted in the public versus private healthcare network in Sergipe. Methods The present analysis used data from the VICTIM Register (VIa Crucis for the Treatment of Myocardial Infarction), a study that aims to analyze and compare the access of STEMI patients to hospitals with capacity to perform angioplasty in the public and private networks of the state of Sergipe. This is a cross-sectional study, with a quantitative approach, developed fromDecember 2014 toMarch 2017. Data collection was performed in the only four hospitals in the state of Sergipe with capacity to performAP, all located in the capital city Aracaju. Among these, only one offers service through SUS, and does not have “open door” care, which requires that the patient be referenced from another health institution to be admitted to that hospital. The other three hospitals offer private service, either through health plans or private payment. To collect data, a study-specific tool, CRF (Case Report Form), was used; data includes information on socio‑demographic conditions, onset of symptoms and clinical presentation, hospitalization data, angiographic procedure, patients’ progression during hospitalization and up to 30 days after AMI. To be filled, the interview with the patient (or with the relative, when the patient had no clinical conditions) was used as source, besides the analysis of the medical record. Patients older than 18 years, with a history consistent with AMI, electrocardiographic confirmation of the STEMI according to the defining criteria of the V Guideline of the Brazilian Society of Cardiology on the treatment of STEMI, 1 and who signed the Free Informed Consent Term (FIC) were included. Those unable to sign had their participation authorized by a person responsible for them; the illiterate patients gave permission by fingerprint. The following patients were excluded: those who died before the interview; who did not characterize the Via Crucis, that is, those who were hospitalized for other causes when they had STEMI; those who refused to participate in the survey; those whose acute STEMI event was characterized as reinfarction (occurring within 28 days of the incident infarction); those who had a change of diagnosis - that is, they entered the tertiary hospitals with an initial diagnosis of STEM, but after having undergone exams, another finding was observed; and those attended through a health plan in a philanthropic hospital. This research was submitted to the Research Ethics Committee of Universidade Federal de Sergipe (UFS) and approved with CAAE no. 23392313.4.0000.5546. Statistical analysis All STEMI patients, representing all the cases treated in the State, were included in the sample, since all the centers with a hemodynamic service were included in the study. To evaluate the association for categorical variables presented in absolute numbers and percentage, Pearson chi-square test was used. Continuous variables were presented by mean and standard deviation and the unpaired Student t-test was used to evaluate the means differences, and its adherence to the normal distribution was tested using Kolmogorov-Smirnov test (p>0.05). In all hypotheses tested, the level of significance was 5% (p<0.05). The SPSS for Windows Version 17 software was used for statistical analysis.  Results Sociodemographic profile A total of 707 patients were analyzed, of which 83% were attended by the public service and 17% by the private network. In both services, most patients were male (67.1% vs 71.2%, p = 0.382), with a mean age of 61.2 ± 12.2 years vs. 62.3 ± 12.2 years (p = 0.332), respectively. Ethnicity was a variable collected based on the self-declaration of the patients involved. In this context, a statistically significant difference was observed when the two services are compared, with 68.7% of the SUS patients declaring being non-whites, while 60% of the patients in the private network declared themselves to be white (p < 0.01) (Table 1). Other expressive data regarding the differences between the patients attended by SUS and the private network are related to social class and educational level. Regarding social class, it can be observed that in the public service 61.2% of the patients had family income consistent with class E (gross family income of up to two minimum wages), while in the private network 33% of the patients were class C (gross family income from 4 to 10 minimum wages) (p < 0.001). Regarding the level of education, 57% of public service patients studied until elementary school, while 30.5% of the patients attended by the private network studied until higher education level (p < 0.001). It is worth mentioning that about 27% of the public service patients never studied (Table 1). Cardiovascular risk factors The cardiovascular risk evaluated for patients from SUS and from the private network admitted to the study were: systemic arterial hypertension, diabetes mellitus, dyslipidemia and smoking. In both services, hypertension was shown to be the most prevalent factor (39.2% vs 71.2%, p = 0.033), followed by dyslipidemia (33.6% vs 55.9%, p < 0.001). Diabetes mellitus 565