IJCS | Volume 31, Nº5, September / October 2018

521 Hoepfner et al. Myocardial infarction in Joinville Int J Cardiovasc Sci. 2018;31(5)520-526 Original Article For this reason, patients’ diagnosis, transportation and treatment should be fast. In 2011, the Ministry of Health implemented an integrated system for AMI management (the Linha de Cuidado do Infarto Agudo do Miocárdio ) through healthcare units of the SUS, and a clinical protocol on acute coronary syndrome (ACS) (the Protocolo Clínico sobre Síndrome Coronariana Aguda ). 2 These were created to propose an integrated action for ACS treatment, grounded on its high prevalence and important role in morbidity and mortality. In the city of Joinville, SUS provides emergency care units, general hospitals and a referral hospital. Coronary angiography and angioplasty are available in the referral hospital only, and none offers cardiac care services available 24 hours a day. Joinville Secretary of Health promoted the publication of a booklet entitled “ Bata na porta certa ” (“Knock on the right door”) to guide healthcare providers and users in directing themselves to the correct units for health assistance. 20 For example, the booklet suggests the best emergency care units for chest pain in the city. Our study aimed to identify where AMI patients sought medical care at first place (the “front door”) and the time elapsed from initial care received by the patients (first medical contact) and myocardial reperfusion. Methods This was a retrospective analysis of medical records, including 112 patients with ST-segment elevation myocardial infarction (STEMI) who had undergone coronary angiography in the period between 09/28/2013 and 05/28/2014. Data were collected at the Catheterization Laboratory, at Santa Catarina State referral hospital, at Joinville Hospital and at three emergency care units of the city. We registered: the place where patients received initial care, the time (min) between pain onset and the moment the patient was seen at the unit; the time (min) between admission to the first unit and admission to the referral hospital; the time (min) between admission to the referral hospital and coronary angiography test; and whether coronary thrombolysis was performed. Due to missing data, the door-to-balloon time was not recorded. When the “front door” tomedical carewas not found in patients’ records, we attempted to contact patients by telephone. In addition, we also collected data on the occurrence of heart failure, myocardial revascularization and death. The study was approved by the ethics committee of Joinville Regional University (UNIVILLE), by Joinville Secretary of Health, and by hospitals and catheterization laboratory involved in the study. Statistical analysis Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 17 (SPSS Inc. Chicago, Illinois). Continuous variables with normal distribution were expressed as mean ± standard deviation, and frequency analysis was used for categorical variables. Data normality was verified by the Kolmogorov-Smirnov test. Between-group comparisons were performed by the Student’s t test for independent, continuous variables and by the chi-square test for nominal variables. The level of significance was set at 5% (95% confidence interval, 95%CI). Results We studied 87 men and 24 women, mean age of 58.3 (23-82) years. The “front door” to the emergency care was the emergency care unit for 44 patients, the referral hospital for 16 patients, the city hospital for 4, the emergency medical service transport system for 5, and primary health centers for 2 patients; in 29 patients this information was not available. The other patients were transfered from other cities. Event duration (time elapsed between pain onset and coronary angiography) was probably shorter than 12 hours in 71 patients (65.7%) and longer than 12 hours in 39. This was in fact an estimate, calculated as the sum of minutes during the period between the first medical assistance and coronary angiography test, since duration of pain was not recorded in the medical records. In addition, in emergency care units, most of the medical records could not be accessed, since they were usually registered behalf of patients and filled in other institution. The medical records of patients referred from other cities were also not available, and we rarely obtained useful information by phone contact in these cases. Percutaneous transluminal angioplasty (PTA) was performed in 92 (82.1%) patients and the door-to- angiography time (DAT) was shorter than 90 minutes in 50 (44.2%) patients (Table 1). No statistically significant difference was seen in DAT, sex or age between patients admitted to the referral hospital and the others. DAT was not available in 14 patients. No patients received thrombolytic drugs.