Disparities In The Use Of Drug-eluting Stents For Diabetic Patients With ST-elevation Acute Myocardial Infarction Assisted In the Public versus Private Network - VICTIM Register

Abstract Background: Primary angioplasty (PA) with placement of either bare metal or drug-eluting stents (DES) represents the main strategy in the treatment of ST-elevation myocardial infarction (STEMI). Diabetic patients, however, represent a special population in STEMI, with high rates of restenosis and unfavorable clinical outcomes, and with the use of DES, level of evidence A and indication class II, being indicated to reduce these damages. Objectives: To evaluate the DES rate of use in patients with STEMI and in the subgroup of diabetics assisted in the public versus private health network in Sergipe. Methods: This is a population-based, cross-sectional study with a quantitative approach using the data from the VICTIM Register. These were collected in the only four hospitals with capacity to perform PA in Sergipe, from December 2014 to March 2017. Results: A total of 707 patients diagnosed with STEMI were evaluated, of which 589 were attended at SUS and 118 at the private network. The use of DES in PA was lower in SUS compared to the private network in both the total sample (10.5% vs 82.4%, p<0.001) and in subgroup diabetic patients (8.7% vs 90.6%, p < 0.001), respectively. In all hypotheses tested, the level of significance was 5% (p < 0.05). Conclusions: The study reveals a disparity in the use of DES during the performance of PA between the public and private network, both in the total sample and the subgroup for diabetics, with lower rates for SUS users, demonstrating the challenges that need to be overcome in order to achieve quality improvements of the services provided.

【摘要】
背景：采用裸金属支架或药物洗脱支架（drug-eluting stents, DES）的直接血管成形术（primary angioplasty, PA）是ST段抬高型心肌梗死（ST-elevation myocardial infarction, STEMI）的主要治疗策略。然而，糖尿病患者是STEMI的特殊人群，其再狭窄发生率高、临床预后不佳；使用药物洗脱支架的证据等级为A级，属于II类适应证，可用于降低此类不良事件风险。
目的：评估巴西塞尔希培州公立与私立医疗网络中，STEMI患者及亚组糖尿病患者的药物洗脱支架使用比例。
方法：本研究为基于人群的横断面定量研究，数据来源于VICTIM登记库。研究数据采集自塞尔希培州仅有的4家具备开展直接血管成形术资质的医院，时间跨度为2014年12月至2017年3月。
结果：本研究共纳入707例确诊STEMI患者，其中589例在巴西统一健康系统（Sistema Único de Saúde, SUS）就诊，118例在私立医疗网络就诊。全样本分析显示，公立医疗网络的药物洗脱支架使用比例显著低于私立医疗网络（10.5% vs 82.4%，P<0.001）；糖尿病亚组分析同样得到类似结果（8.7% vs 90.6%，P<0.001）。本研究所有检验的显著性水平均设定为5%（P<0.05）。
结论：本研究揭示，无论在全样本还是糖尿病亚组中，公立与私立医疗网络在直接血管成形术中的药物洗脱支架使用比例均存在显著差异，公立医疗网络的使用比例更低，这表明要实现医疗服务质量提升仍需攻克诸多挑战。