IJCS | Volume 32, Nº2, March/April 2019

130 Table 2 - Procedural characteristics Variable All (n = 542) 2011 (n = 45) 2012 (n = 56) 2013 (n = 88) 2014 (n = 84) 2015 (n = 121) 2016 (n = 148) P trend Arterial access Radial 340 (62.7) 9 (20) 27 (48.2) 52 (59.1) 49 (58.3) 84 (69.2) 119 (80.4) < 0.0001 Femoral 202 (37.3) 36 (80) 29 (51.8) 36 (40.9) 35 (41.7) 37 (30.8) 29 (19.6) < 0.0001 Angioplasty BMS 483 (90.3) 41 (97.6) 56 (100) 88 (100) 81 (97.6) 108 (90) 111 (75) < 0.0001 Thrombus aspiration 166 (30.6) 30 (66.7) 46 (82.1) 51 (58) 21 (25) 14 (11.76) 4 (2.7) < 0.0001 Initial TIMI flow 0-1 422 (80.1) 40 (88.9) 45 (80.4) 66 (75.9) 61 (72.6) 94 (81) 116 (83.5) 0.72 Final TIMI flow 2-3 511 (95) 44 (97.8) 55 (98.2) 78 (88.6) 78 (92.9) 115 (95.8) 141 (97.2) 0.48 Culprit artery ADA 222 (41.4) 22 (48.9) 21 (38.9) 40 (46.0) 32 (38.6) 44 (36.7) 63 (42.9) 0.53 RCA 212 (39.6) 17 (37.8) 22 (40.7) 30 (34.5) 35 (42.2) 49 (40.8) 59 (40.1) 0.58 No reflow 32 (6.2) 2 (4.4) 0 (0) 5 (5.8) 1 (1.2) 13 (10.8) 11 (8.5) 0.01 Distal embolization 21 (4.1) 1 (2.2) 0 (0) 1 (1.2) 1 (1.2) 11 (9.2) 7 (5.4) 0.008 CIN 70 (12.9) 6 (13.3) 6 (10.7) 12 (13.6) 16 (19) 16 (13.2) 14 (9.5) 0.49 Radiation (Gy) 2,112 (1,215-3,192) 2,581 (518-3,697) 2,883 (1,404-3,412) 2,107 (1,476-3,370) 2,613 (1,608-3,582) 2,548 (1,650-3,379) 1,511 (902-2,491) < 0.001 Contrast volume (mL) 180 (140-230) 180 (150-250) 200 (150-230) 177 (150-232) 200 (150-280) 180 (142-227) 150 (120-200) < 0.001 Values are expressed as median (interquartile range) or number (%). BMS: bare metal stent; ADA: anterior descendent artery; RCA: right coronary artery; CIN contrast-induced nephropathy. Machado et al. Care changes in primary PCI Int J Cardiovasc Sci. 2019;32(2)125-133 Original Article and lower stent thrombosis rates. 15 Despite the lower rates and their delay in being routinely applied, it is an example of more people having access to new therapies. Another example of in healthcare assistance improvement, i.e., the use of SAMU, has been increasing in recent years in our cohort. One might suggest the population acknowledges that such care is one of the fastest and most efficient means of having access to different technologies, either for providing assistance or removal to a health service. The percentage of heart disease (angina, cardiac arrest, hypertensive crisis, AMI) in the population treated by the emergency medical services (EMS) is 17.4% 16 and the response time, one of the qualitymarkers of the provided service, was reduced from 21 minutes to 15 minutes in 2016, according to Porto Alegre’s Health Agency. 17 The reduction in time demonstrates an improvement in the care of the patients who use the emergency services. We found a significant reduction in the door-to- balloon time, in agreement with the current guidelines that recommend a door-to-balloon time < 90 minutes; however, the delay should be shorter, preferably within 60 min, in patients presenting early, with a large amount of myocardium at risk. 12,13 Despite these favorable changes in the service routine, the observed mortality has remained constant, with an approximate rate of 10.0 to 11.0%. When compared to the ACCEPT study, 18 a Brazilian national-based registry, which showed a mortality rate of 3.4%, the mortality found in our service is high; however, these data can be justified due to the disease severity observed in our patients, of which approximately 13.0% presented with Killip class III/IV,