Methods: Patients presenting to our center from December 2009 to December 2014 were prospectively and consecutively included. The main inclusion criteria was STEMIin the first 12 hours undergoing primary percutaneous coronary intervention (pPCI). Our center is a tertiary cardiology referral center, perfomingmore than 400 pPCIs per year. Clinical charateristics and 2-years follow-up were evaluated by one of the study investigators, and patients from the public vs private health care assistance were compared.
Results: In the study period, 1,827 patients were included, 75% from public careand 24% fromprivate care. Patients from the public healthcare were younger and more frequently male, more frequently smokers and with diabetes mellitus, and had lower education level and lower incomes than patients from the public healthcare. Patients from the public assistance also presented lower rates of dyslipidemia,butthere was no statistical difference in the frequence of hypertension. The baseline angiographic characteristics and the immediate results of the pPCI procedure were not statistically different. Regarding medical treatment, nitratesand statins were used more frequentlyin patients from public healthcare, but the use of aspirin and clopidogrel was similar between groups. Enoxaparin, ACE inhibitors and ARBs were prescribed more often for patients treated with private health insurance, at admission and at discharge. The rates of in-hospital major cardiovascular events were similar between both groups. In the clinical follow-up at 30 days and one year, reinfarction occurred more frequently in patients from public assisstance, but mortality was similar.
Conclusions: In a large reference cardiology center in Brazil, patients with STEMI presented distinct clinical characeristics according to the type of insurance, public or private, as of different long-term clinical outcomes. However, there was no difference regarding in-hospital adverse cardiovascular outcomes and results of the pPCI procedure. These discrepancies may suggest a better hospital than ambulatory care in patients with a public healthcare insurance in our country.
To cite this abstract:Reichert, GB; Weber, CK; Schmidt, MM; Azeredo, ML; Souza, BDN; Moraes, MAPD; Gottschall, CAM; Quadros, ASD . INFLUENCE OF PUBLIC OR PRIVATE ASSISTANCE IN THE CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 91. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/influence-of-public-or-private-assistance-in-the-clinical-characteristics-and-outcomes-of-patients-with-st-elevation-myocardial-infarction/. Accessed April 1, 2020.