Structure, Process, and Mortality Associated with Acute Coronary Syndrome Management in Guatemala's National Healthcare System: The ACS-GT Registry

• Published in: Global heart Vol. 17; no. 1; p. 84
• Main Authors: Cornejo-Guerra, José Antonio, Ramos-Castro, Magda Isabel, Gil-Salazar, Mariana, Leal-Wittkowsky, Sofia, Santis-Mejía, Juan Carlos, León, Elisa María Anleu-De, Castro-Alvarado, Oscar Fernando, López-Quiñónez, Boris Rudy Alexander, Illescas-González, Edgar Alexander, Overall-Salazar, Paola, Rodríguez-Cifuentes, Luis Antonio, Miranda-Sandoval, Karla Yesenia, Pineda, Juan Pablo, Flores-Andrade, Kevin Oneal, Pérez-Reyes, Roberto Antonio, Girón-Blas, Sofía Waleska, Samayoa-Ruano, Josué Fernando
• Format: Journal Article
• Language: English
• Published: England Ubiquity Press 01.01.2022
• Subjects: acute coronary syndrome; Acute Coronary Syndrome - epidemiology; Acute Coronary Syndrome - therapy; Adult; Angina, Unstable - drug therapy; Angina, Unstable - therapy; Delivery of Health Care; Female; fibrinolysis; guatemala; Guatemala - epidemiology; Humans; Male; Myocardial Infarction; Non-ST Elevated Myocardial Infarction; Original Research; Percutaneous Coronary Intervention; Prospective Studies; Registries; st elevation myocardial infarction; ST Elevation Myocardial Infarction - epidemiology; ST Elevation Myocardial Infarction - therapy; Treatment Outcome; Guatemala; fibrinolysis; Guatemala; percutaneous coronary intervention; acute coronary syndrome; ST elevation myocardial infarction; non-ST elevated myocardial infarction
• ISSN: 2211-8179; 2211-8160; 2211-8179
• DOI: 10.5334/gh.1168

Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). The leading cause of mortality in Guatemala is acute myocardial infarction (AMI) and there is no established national policy nor current standard of care. Describe the factors that influence ACS outcome, evaluating the national healthcare system's quality of care based on the Donabedian health model. The ACS-Gt study is an observational, multicentre, and prospective national registry. A total of 109 ACS adult patients admitted at six hospitals from Guatemala's National Healthcare System were included. These represent six out of the country's eight geographic regions. Data enrolment took place from February 2020 to January 2021. Data was assessed using chi-square test, Student's t-test, or Mann-Whitney U test, whichever applied. A p-value < 0.05 was considered statistically significant. One hundred and nine patients met inclusion criteria (80.7% STEMI, 19.3% NSTEMI/UA). The population was predominantly male, (68%) hypertensive (49.5%), and diabetic (45.9%). Fifty-nine percent of STEMI patients received fibrinolysis (alteplase 65.4%) and none for primary Percutaneous Coronary Intervention (pPCI). Reperfusion success rate was 65%, and none were taken to PCI afterwards in the recommended time period (2-24 hours). Prognostic delays in STEMI were significantly prolonged in comparison with European guidelines goals. Optimal in-hospital medical therapy was 8.3%, and in-hospital mortality was 20.4%. There is poor access to ACS pharmacological treatment, low reperfusion rate, and no primary, urgent, or rescue PCI available. No patient fulfilled the recommended time period between successful fibrinolysis and PCI. Resources are limited and inefficiently used.