{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:16:48Z","timestamp":1782991008866,"version":"3.54.5"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,7,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Few data exist on regional systems of care for the treatment of\n              <jats:styled-content style=\"fixed-case\">ST<\/jats:styled-content>\n              \u2010segment\u2013elevation myocardial infarction (\n              <jats:styled-content style=\"fixed-case\">STEMI<\/jats:styled-content>\n              ) in developing countries. Our objective was to describe temporal trends in 30\u2010day mortality and identify predictors of mortality among\n              <jats:styled-content style=\"fixed-case\">STEMI<\/jats:styled-content>\n              patients enrolled in a prospective registry in Brazil.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              From January 2011 to June 2013, 520 patients who received initial\n              <jats:styled-content style=\"fixed-case\">STEMI<\/jats:styled-content>\n              care at 23 nonspecialized public health units or hospitals, some of whom were transferred to a public cardiology referral center, were identified through a regional\n              <jats:styled-content style=\"fixed-case\">STEMI<\/jats:styled-content>\n              network supported by telemedicine and the local prehospital emergency medical service. We stratified patients into five 6\u2010month periods based on presentation date. Mean age (\u00b1\n              <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>\n              ) of patients was 62.0 (\u00b112.2) years, and 55.6% were men. The mean Global Registry of Acute Coronary Events (\n              <jats:styled-content style=\"fixed-case\">GRACE<\/jats:styled-content>\n              ) score was 145 (\u00b134). Overall mortality at 30\u00a0days was 15.0%. Use of dual antiplatelet therapy and statins increased significantly from baseline (January 2011) to period 5 (June 2013): 61.8% to 93.6% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and 60.4% to 79.7% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), respectively. Rates of primary reperfusion also increased (29.1%\u201353.8%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), and more patients were transferred to the referral center (44.7%\u201376.3%;\n              <jats:italic>P<\/jats:italic>\n              =0.001). Thirty\u2010day mortality rates decreased from 19.8% to 5.1% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). In multivariable analysis, factors independently associated with 30\u2010day mortality were higher\n              <jats:styled-content style=\"fixed-case\">GRACE<\/jats:styled-content>\n              score, history of previous stroke, lack of transfer to the referral center, and lack of use of optimized medical therapy.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Implementation of a regional\n              <jats:styled-content style=\"fixed-case\">STEMI<\/jats:styled-content>\n              system was associated with lower mortality and higher use of evidence\u2010based therapies.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.008624","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T09:21:29Z","timestamp":1530868889000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Implementation of a Regional Network for ST\u2010Segment\u2013Elevation Myocardial Infarction (STEMI) Care and 30\u2010Day Mortality in a Low\u2010 to Middle\u2010Income City in Brazil: Findings From Salvador's STEMI Registry (RESISST)"],"prefix":"10.1161","volume":"7","author":[{"given":"Nivaldo Menezes","family":"Filgueiras Filho","sequence":"first","affiliation":[{"name":"Universidade Federal do Estado de S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Universidade do Estado da Bahia Salvador Bahia Brazil"},{"name":"Universidade Salvador \u2013 rede Laureate Salvador Bahia Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilson Soares","family":"Feitosa 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Filho","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Atendimento M\u00f3vel de Urg\u00eancia \u2013 SAMU 192 Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa Gordilho Mutti","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Atendimento M\u00f3vel de Urg\u00eancia \u2013 SAMU 192 Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa Silva","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Atendimento M\u00f3vel de Urg\u00eancia \u2013 SAMU 192 Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos Nogueira de Oliveira","family":"Rios","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Atendimento M\u00f3vel de Urg\u00eancia \u2013 SAMU 192 Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Figueiredo","family":"C\u00e2mara","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Atendimento M\u00f3vel de Urg\u00eancia \u2013 SAMU 192 Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Oliveira","family":"Novais","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Atendimento M\u00f3vel de Urg\u00eancia \u2013 SAMU 192 Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo de Souza","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Atendimento M\u00f3vel de Urg\u00eancia \u2013 SAMU 192 Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance Silva","family":"Ballalai","sequence":"additional","affiliation":[{"name":"Universidade Salvador \u2013 rede Laureate Salvador Bahia Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Vitoria","family":"De 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