Análise dos atendimentos pré-hospitalares de pacientes com infarto com supradesnivelamento do segmento ST (IAMCSST) submetidos à terapia com tenecteplase (TNK)

Abstract

Cardiovascular diseases (CVD) are the leading cause of death in Brazil and worldwide, with particular emphasis on ST-Segment Elevation Myocardial Infarction (STEMI). However, few studies are conducted focusing on pre-hospital care for this condition, especially in countries where access to Primary Percutaneous Coronary Intervention (pPCI) is limited. The aim of this study was to analyze data regarding the strategy adopted for the use of pharmacoinvasive therapy in Paraná, seeking to identify indicators of its efficacy in reducing mortality due to STEMI in the state’s public healthcare system. A retrospective study was conducted on 804 care records registered in the database of the Paraná State Department of Health, attended through the Unified Health System (SUS) between 2020 and 2024, investigating the association between pre-hospital care times, different transport modalities, clinical risk factors, and outcomes within 30 days in STEMI patients submitted to Tenecteplase (TNK) therapy. In the data analysis, Student’s T-test was used to compare time variables; for the advantage between transport modalities, Survival Analysis (Harrington and Fleming G-rho test family) from the survival package of R software was applied. The Kaplan-Meier curve was used to assess minimum time and distance, and the chi-square test was used to test the hypothesis of equality of curves; the Cox regression model was used for proportional hazards, calculated with a time-dependent coefficient evaluated by Schoenfeld residuals to assess mortality and risk across variables. Among the main results, the following stand out: the predominance of ischemic events in males (72.39%); that men had myocardial infarctions earlier than women (3.8 years); that women had a mean TIMI Risk score of 4.85, while in men the mean TIMI Risk score was 3.91 (p<0.001); and that, proportionally, women died more than men (p>0.001). Regarding risk factors, higher age was associated with higher mortality (especially after 75 years of age); and hypotension during the event with SBP < 100 mmHg also increased mortality. It was found that the therapy proved effective, with 79.6% of patients showing improvement in pain and 54.8% showing a reduction of at least 50% in ST-segment elevation. Air transport demonstrated a significant advantage on routes exceeding 74 km. Data from the Ministry of Health’s mortality information system show a decrease from 52.27 deaths per hundred thousand inhabitants in 2019 to 47.82 deaths per hundred thousand inhabitants in 2024 in Paraná. It can be concluded that the adoption of pharmacoinvasive therapy in prehospital care was a beneficial strategy in a developing country, validating its expansion within the public healthcare network. However, the need for improvement in patient triage, optimization of care times, and the elimination of healthcare coverage gaps is emphasized in order to maximize the benefits of this approach.