IJCS | Volume 31, Nº5, September / October 2018

525 1. PiegasLS,FeitosaGS,MattosLA,NicolauJC,RossiNetoJM,etal;Sociedade BrasileiradeCardiologia.IVDiretrizdaSociedadeBrasileiradeCardiologia sobre tratamento do infarto agudo do miocárdio com supradesnível do segmento ST. Arq Bras Cardiol. 2009;93(6 supl 2):e179-264. 2. Brasil. Ministério da Saúde. Portaria nº 1600, 07/06/2011. Rede de atenção às urgências e emergências. Institui a linha de cuidado do infarto agudo do miocárdio no âmbito do Sistema Único de Saúde (SUS), bem como o protocolo clínico sobre síndrome coronariana aguda. Diário Oficial da União Brasília (DF). 08 de julho de 2011. Seção 1. p. 70. 3. Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) andACC/AHA/ SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54(23):2005-41. Erratum in: J Am Coll Cardiol. 2009;54(25):2464. J Am Coll Cardiol. 2010;55(6):612. 4. Gibson CM. Time is myocardium and time is outcomes. Circulation. 2001;104(22):2632-24. 5. Fu Y, Goodman S, Chang WC, Van de Werf F, Granger CB, Armstrong PW. Time to treatment influences the impact of ST-segment resolution on one-year prognosis: insights from the assessment of the safety and efficacy of a new thrombolytic (ASSENT-2) trial. Circulation. 2001;104(22):2653-9. 6. Goldberg RJ, Gurwitz JH, Gore JM. Duration of, and temporal trends (1994–1997) in, prehospital delay in patients with acute myocardial infarction: the Second National Registry of Myocardial Infarction. Arch Intern Med. 1999;159(18):2141-7. References Hoepfner et al. Myocardial infarction in Joinville Int J Cardiovasc Sci. 2018;31(5)520-526 Original Article Study limitations Limitations of the study include its retrospective nature, the limited number of patients, the inclusion of patients undergoing catheterization only, the impossibility of determining the time interval from pain onset, patient admission and procedure, and the lack of data at the time of angioplasty. Conclusions We identified a flawed healthcare system for STEMI management, in which the first medical contact rarely occurs in the referral hospital, physicians have difficulties in diagnosing the disease and do not use validated therapeutic approaches, and much data are missing from the medical records (which are filed in inadequate locations). Difficulties are encountered in the transfer of patients to the referral hospital and the emergency medical services are infrequently called, causing a delay in mechanical reperfusion. The importance of the catheterization laboratory is highlighted, with more than half of patients treated within a DAT consistent with current guidelines, reinforcing the need for a direct transportation of patients to this facility. We recommend the implementation of an integrated system for AMI management compatible with local conditions and patients’ needs, characterized by centralized coordination, continuing education of the medical staff, presence of paramedics trained in ECG and use of thrombolysis therapy. We believe that the situation here described is not exclusive of the city of Joinville, justifying and encouraging the development of further studies and improvements in the system. We suggest a prospective, continuing study to evaluate the development and adherence of the system to current guidelines. Author contributions Conception and design of the research: Hoepfner C. Acquisition of data: Roma E, Lana JV, Santin AL, Borga AL, Yamamoto AC, Techentin JV. Analysis and interpretation of the data: Hoepfner C, Roma E, Lana JV, Santin AL. Writing of the manuscript: Hoepfner C, Lana JV, Santin AL, Borga AL, Yamamoto AC, Techentin JV. Critical revision of themanuscript for intellectual content: Hoepfner C, Roma E, Lana JV, Santin AL. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This studywas approvedby theEthicsCommitteeof the Fundação Educacional da Região de Joinville - UNIVILLE under the protocol number 33651114.6.0000.5366. All the procedures in this studywere in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study.