Disparities in access and three-year survival of patients with ST-elevation myocardial infarction treated in percutaneous coronary intervention-capable hospitals within the Brazilian public and private healthcare systems: The VICTIM extended registry.

OBJECTIVES: Disparities in the management and outcomes of ST-segment elevation myocardial infarction (STEMI) between public and private healthcare sectors are a critical concern in middle-income countries. In Brazil, national data on long-term survival and quality of STEMI care are limited. This study compared access to care, treatment strategies, and three-year survival among STEMI patients treated in Brazil's public and private healthcare system. STUDY DESIGN: Prospective cohort study. METHODS: Data were derived from the VICTIM Registry, enrolling 1082 STEMI patients admitted to all percutaneous coronary intervention (PCI)-capable hospitals in Sergipe, Northeast Brazil, from 2014 to 2018. Patients were stratified by healthcare sector: public (Sistema Único de Saúde, SUS) or private. Clinical characteristics, access to care, treatments, and three-year survival were assessed. Cox proportional hazards models estimated hazard ratios (HRs) for mortality, adjusted for demographic and clinical variables. RESULTS: 82.5 % were treated in the public sector. SUS patients experienced longer pre-hospital delays (median 10.3 vs. 5.2 h; p < 0.001), lower reperfusion rates (49.8 % vs. 67.2 %; p < 0.001), and suboptimal use of guideline-recommended medications. Over a median follow-up of 38.9 months, mortality was higher in the SUS group (31.2 % vs. 21.2 % adjusted HR 1.43, 95 % CI 1.21-1.69; p = 0.001). Even among patients receiving reperfusion, SUS patients had higher mortality than those in the private sector. CONCLUSIONS: Our findings reveal significant disparities in STEMI management and long-term survival between Brazil's public and private healthcare sectors. Strengthening emergency networks, expanding access to reperfusion, and improving adherence to guidelines are essential to reduce mortality in public healthcare settings.

Duke Scholars

Author Renato Delascio Lopes Medicine, Cardiology