title: ST-Elevation myocardial infarction network: systematization in 205 cases reduced clinical events in the public health care system.
abstract: BACKGROUND
  The major cause of death in the city of São Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15% and 20% due to difficulties inherent in large metropoles.
  
  
  OBJECTIVE
  To describe in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network).
  
  
  METHODS
  Health care teams of four emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé and Saboya) of the periphery of the city of São Paulo and advanced ambulances of the Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU) were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis) or in 6 to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni- and multivariate analysis.
  
  
  RESULTS
  From January 2010 to June 2011, 205 consecutive patients used the STEMI Network, and the findings were as follows: 87 anterior wall infarctions; 11 left bundle-branch blocks; 14 complete atrioventricular blocks; and 14 resuscitations after initial cardiorespiratory arrest. In-hospital mortality was 6.8% (14 patients), most of which due to cardiogenic shock, one hemorrhagic cerebrovascular accident, and one bleeding.
  
  
  CONCLUSIONS
  The organization in the public health care system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer, and tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.
authors.affiliation: Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil. acvcaluza@cardiol.br
authors.forename: Ana Christina Vellozo
authors.initials: AC
authors.lastname: Caluza
authors.forename: Adriano H
authors.initials: AH
authors.lastname: Barbosa
authors.forename: Iran
authors.initials: I
authors.lastname: Gonçalves
authors.forename: Carlos Alexandre L de
authors.initials: CA
authors.lastname: Oliveira
authors.forename: Lívia Nascimento de
authors.initials: LN
authors.lastname: Matos
authors.forename: Claus
authors.initials: C
authors.lastname: Zeefried
authors.forename: Antonio Célio C
authors.initials: AC
authors.lastname: Moreno
authors.forename: Elcio
authors.initials: E
authors.lastname: Tarkieltaub
authors.forename: Cláudia Maria R
authors.initials: CM
authors.lastname: Alves
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D001938:Brazil; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D009313:National Health Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D010865:Pilot Projects; D013997:Time Factors