Arq. Bras. Cardiol. 2024; 121(7): e20240311

The Price of Delay: Socioeconomic Disparities and Diagnostic Oversights in Occlusion Myocardial Infarction Care

José Nunes de Alencar , Jesse T. T. McLaren

DOI: 10.36660/abc.20240311i

Acute myocardial infarction with acute coronary occlusion represents the most severe and urgent facet of acute coronary syndromes. Seminal studies have taught us that reestablishing coronary flow in patients with occluded arteries, whether through thrombolysis or primary angioplasty, can alter the natural history of the disease and significantly reduce mortality associated with this syndrome.^,

The authors of “The Clinical and Economic Impact of Delayed Reperfusion Therapy: Real-World Evidence” provide compelling data from a wealthy metropolitan region in Brazil, concluding that each additional hour of delay in reperfusion therapy was associated with a 6.2% increase (95% confidence interval: 0.3% to 11.8%, p = 0.032) in the risk of in-hospital mortality. In addition, overall costs were 45% higher among individuals treated after 9 hours compared to those treated within the first 3 hours, which was mainly due to in-hospital costs (p = 0.005). Gioppatto et al. also note, from other studies, the financial impacts on patients and families due to delayed reperfusion, and they call for ST elevation myocardial infarction (STEMI) networks to address the uneven distribution of percutaneous coronary intervention (PCI)-capable centers.

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