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

Glob Heart. 2022 Dec 1;17(1):84. doi: 10.5334/gh.1168. eCollection 2022.

Abstract

Background: 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.

Objective: Describe the factors that influence ACS outcome, evaluating the national healthcare system's quality of care based on the Donabedian health model.

Methods: 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.

Results: 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%.

Conclusions: 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.

Keywords: Guatemala; ST elevation myocardial infarction; acute coronary syndrome; fibrinolysis; non-ST elevated myocardial infarction; percutaneous coronary intervention.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome* / epidemiology
  • Acute Coronary Syndrome* / therapy
  • Adult
  • Angina, Unstable / drug therapy
  • Angina, Unstable / therapy
  • Delivery of Health Care
  • Female
  • Guatemala / epidemiology
  • Humans
  • Male
  • Myocardial Infarction*
  • Non-ST Elevated Myocardial Infarction*
  • Percutaneous Coronary Intervention*
  • Prospective Studies
  • Registries
  • ST Elevation Myocardial Infarction* / epidemiology
  • ST Elevation Myocardial Infarction* / therapy
  • Treatment Outcome

Grants and funding

The study was supported by the Bioethics Committee in Health Investigation of Universidad de San Carlos de Guatemala, under broad approval number AC-14-2020. The funding agencies did not have any role in the registry design, analysis and interpretation of data.