Arq. Bras. Cardiol. 2022; 119(6): 979-980
High Mortality for Myocardial Infarction in Latin America and the Caribbean: Making the Case for Systems of Care Implementation in Brazil
Luisa C. C. Brant
, Luiz G. Passaglia
This Short Editorial is referred by the Research article "Hospital Mortality from Myocardial Infarction in Latin America and the Caribbean: Systematic Review and Meta-Analysis".
Ischemic heart disease (IHD) is the leading cause of death worldwide, and while in high-income countries (HIC), substantial declines in mortality rates for IHD were observed in the last decades, the same did not occur in low- and middle-income countries (LMIC). The final event in the chain of IHD is myocardial infarction (MI), which can be classified based on the electrocardiogram in ST-segment elevation MI (STEMI), and non-ST-segment elevation MI (NSTEMI) – the first having higher lethality. Mortality rates for both MI presentations can be reduced by timely diagnosis and treatment according to current guidelines, including reperfusion therapy for STEMI. In HIC, such as the US, STEMI in-hospital mortality varied from 3.5% for individuals receiving primary percutaneous coronary angioplasty to 14.9% for those receiving no reperfusion, while in European countries, mortality as low as 2.5% has been reported.,
In this issue of the Journal, the article “Hospital Mortality from Myocardial Infarction in Latin America and the Caribbean: Systematic Review and Meta-Analysis” brings a welcome addition regarding MI in-hospital mortality in LMIC from Latin America and the Caribbean from 2000 to 2020. Using sound methodology, the authors made a meta-analysis of data from 38 studies, mostly conducted in Brazil, Cuba, and Argentina: 35 for STEMI with 28,878 individuals, and 9 for NSTEMI with 2,377 individuals. Pooled analysis demonstrated that in-hospital mortality for STEMI was 9.9% (95%CI: 9.1–10.7), with moderate to high heterogeneity (I2=74%). Chile had the lowest mortality (8.5%; 95%CI: 5.3-13.5), and Colombia the highest (15%; 95%CI: 10.1-21.7), with Brazil showing a mortality of 9.6% (95%CI: 8.3-11.0); however, no statistical difference was found among countries (p=0.47). For NSTEMI, in-hospital mortality was 7.2% (95% CI: 5.5 – 9.3), also with moderate to high heterogeneity (I2 = 63%), explained (I2=0%) by the exclusion of one outlier study.
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