title: Integrated regional networks for ST-segment-elevation myocardial infarction care in developing countries: the experience of Salvador, Bahia, Brazil.
abstract: BACKGROUND
  Regionalized integrated networks for ST-segment-elevation myocardial infarction (STEMI) care have been proposed as a step forward in overcoming real-world obstacles, but data are lacking on its performance in developing countries. We describe an integrated regional STEMI network in Salvador, Bahia, Brazil.
  
  
  RESULTS
  The network was created in 2009. It was coordinated by the prehospital emergency medical service and encompassed the public emergency system (prehospital mobile units, community-based emergency units, general hospitals, and cardiology reference centers). The 12-lead ECGs are interpreted via telemedicine. This network operates as follows: The Telemedicine Center sends each ECG suggestive of STEMI to a Regional STEMI Alert Team, which, together with emergency medical services, offers support for thrombolysis or immediate transfer for primary percutaneous coronary intervention. In 14 months, there were 433 suspected victims, of which in 287 (76.5%) the STEMI could be confirmed (age, 62.1±12.5 years; 63.4% men). Most of them were self-transported. The median pain-to-admission time was 180 minutes (interquartile range, 90-473 minutes), and the median admission-to-ECG time was 159.5 minutes (interquartile range, 83.5-340 minutes). The median interval time between the ECG and the telemedicine report was 31 minutes (interquartile range, 21-44 minutes). For those who sought medical attention and had an ECG performed within 12 hours after symptoms onset (n=119), the reperfusion rate was 75.6% (34.4% by thrombolysis and 65.6% by primary percutaneous coronary intervention).
  
  
  CONCLUSIONS
  Regional STEMI networks may be feasible in developing countries. Preliminary results showed this network to be effective, achieving primary reperfusion rtes comparable with those reported internationally despite the obstacles faced.
authors.affiliation: Federal University of Bahia, Salvador, Bahia, Brazil. davisolla@hotmail.com
authors.forename: Davi Jorge Fontoura
authors.initials: DJ
authors.lastname: Solla
authors.forename: Ivan de Mattos
authors.initials: Ide M
authors.lastname: Paiva Filho
authors.forename: Jacques Edouard
authors.initials: JE
authors.lastname: Delisle
authors.forename: Alecianne Azevedo
authors.initials: AA
authors.lastname: Braga
authors.forename: João Batista de
authors.initials: JB
authors.lastname: Moura
authors.forename: Xavier de
authors.initials: Xd
authors.lastname: Moraes
authors.forename: Nivaldo Menezes
authors.initials: NM
authors.lastname: Filgueiras
authors.forename: Marcela Embiruçu
authors.initials: ME
authors.lastname: Carvalho
authors.forename: Mariana Steque
authors.initials: MS
authors.lastname: Martins
authors.forename: Orlando
authors.initials: O
authors.lastname: Manganotti Neto
authors.forename: Paulo
authors.initials: P
authors.lastname: Roberto Filho
authors.forename: Pollianna de Souza
authors.initials: Pde S
authors.lastname: Roriz
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D016507:Cardiology Service, Hospital / Q000458:organization & administration; D019058:Community Networks / Q000458:organization & administration*; D003906:Developing Countries; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D006769:Hospitals, General / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012189:Retrospective Studies; D017216:Telemedicine / Q000458:organization & administration; D013997:Time Factors