Arq. Bras. Cardiol. 2024; 121(11): e20240604
The ACCEPT Study and the Management of Ischemic Myocardial Disease in Brazil: Challenges and Opportunities in a Continental Country
This Short Editorial is referred by the Research article "Myocardial Infarction with ST Elevation and Reperfusion Therapy in Brazil: Data from the ACCEPT Registry".
Ischemic myocardial disease, particularly in its acute manifestation as an acute coronary syndrome (ACS), remains one of the main public health challenges in Brazil and the world., In this context, the ACCEPT (Acute Coronary Syndrome Registry) study emerges as a crucial source of epidemiological and clinical information on the management of ACS in the Brazilian scenario, with the aim of evaluating evidence-based therapies, the occurrence of outcomes, use of reperfusion and predictors for not receiving reperfusion in patients with ACS in a multicenter national registry.,
Brazil, with its continental dimensions and marked regional disparities, presents a unique challenge in implementing uniform strategies for the treatment of SCA. The study ACCEPT not only provides valuable data on the prevalence and types of ACS found in the country but also sheds light on the different therapeutic approaches adopted in different regions. Myocardial revascularization is a fundamental pillar in the treatment of ACS, especially in ST-segment elevation myocardial infarction (STEMI). ACCEPT demonstrates that, although primary pPCI (Primary Percutaneous Coronary Intervention) is considered the gold standard for STEMI, its availability and application vary significantly between Brazilian regions. In metropolitan areas and referral centers, primary PCI is often the first choice, in line with international guidelines that recommend its performance within 90 minutes after first medical contact. However, in less developed or rural regions, where access to hemodynamic centers is limited, fibrinolysis still plays a crucial role as an initial reperfusion strategy. This regional disparity in access to advanced healthcare resources highlights the importance of adaptive strategies in the management of ACS. The pharmaco-invasive approach, which combines initial fibrinolysis with subsequent transfer for PCI, emerges as a promising alternative in settings where immediate access to PCI is not feasible.–
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