IJCS | Volume 31, Nº5, September / October 2018

DOI: 10.5935/2359-4802.20180056 520 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2018;31(5)520-526 Mailing Address: Clovis Hoepfner Orestes Guimaraes, 422, Apto 901. Postal Code: 89204-060, Centro, Joinville, SC - Brazil E-mail: hoepfner@cardiol.br , clinica@espacovitagt.com.br Knock on the Right Door. Howwe are Treating the Patient with AcuteMyocardial Infarction Clóvis Hoepfner, 1,3 Edilson Roma, 2 Jessé Vinicius Lana, 3 Ana Luysa Santin, 3 Ana Lavratti Borga, 1 Ana Cláudia Yamamoto, 1 Juliana Vicente Techentin 1 Hospital Municipal São José, 1 Joinville, SC - Brazil Hospital Regional Hans Dieter Schmidt, 2 Joinville, SC - Brazil Universidade da Região de Joinville, 3 Joinville, SC - Brazil Manuscript received December 07, 2017, revised manuscript Abril 26, 2018, accepted May 03, 2018. Abstract Background: To reduce mortality of acute myocardial infarction, medical care must be provided within the first hours of the event. Objective: To identify the “front door” tomedical care of acute coronary patients and the time elapsed between patients’ admission and performance of myocardial reperfusion in the public health system of the city of Joinville, Brazil. Methods: The study was a retrospective analysis of the medical records of 112 consecutive patients diagnosed with acute myocardial infarction by coronary angiography. We identified the place of the first medical contact and calculated the time between admission to this place and admission to the referral hospital, as well as the time until coronary angiography, with or without percutaneous transluminal angioplasty. A descriptive analysis of data was made using mean and standard deviation, and a p < 0.05 was set as statistically significant. Results: Only 16 (14.3%) patients were admitted through the cardiology referral unit. Door-to-angiography time was shorter than 90 minutes in 50 (44.2%) patients and longer than 270 minutes in 39 (34.5%) patients. No statistically significant difference was observed in door-to-angiography time between patients transported directly to the referral hospital and those transferred from other health units (p < 0.240). Considering the time between pain onset and angiography, only 3 (2.9%) patients may have benefited from myocardial reperfusion performed within less than 240 minutes. Conclusion: Management of patients with acute myocardial infarction is not in conformity with current guidelines for the treatment of this condition. The structure of the healthcare system should be urgently modified so that users in need of emergency services receive adequate care in accordance with local conditions. (Int J Cardiovasc Sci. 2018;31(5)520-526) Keywords: Guidelines Adherence; Failure to Rescue, Health Care; Unified Health, System; Myocardial Infarction; Emergency Medical Services. Introduction Acute myocardial infarction (AMI) is one of the major causes of death in Brazil. 1,2 Heart failure and sudden death, themost severe complications of AMI, are themost serious manifestations of atherosclerotic disease. The majority of deaths occur in the first 24 hours of disease onset, and nearly half of them in the first hour. 1-3 Similar to the in-hospital mortality, 30-day mortality decreased from 8.6% to 3.6% in some North American states between 1988 and 2000. 3 In Brazil, 30-day mortality is 15.4% 2 according to the Brazilian Unified Health System (SUS) Computing Department (DATASUS). When AMI patients seek medical care, therapeutic interventions should be promptly performed to result in beneficial outcomes. Fibrinolytic therapy and coronary angioplasty have no or low efficiency when performed after four hours of AMI with ST-segment elevation. 1-19