Influence of Medical Coverage on the Treatment and Prognosis of ST-segment Elevation Myocardial Infarction. SCAR Registry Subanalysis

pp. 402-407

Abstract

Background: The Acute Coronary Syndromes in Argentina (SCAR) registry analyzed in-hospital myocardial infarction outcome in patients with different medical coverage provided by the healthcare system; this has led to the present subanalysis derived from the SCAR registry.
Objective: The aim of this study was to determine the influence of medical coverage on myocardial infarction in-hospital prognosis.
Methods: The SCAR registry was a cross-sectional, prospective, multicenter study including 476 patients with ST-segment elevation acute myocardial infarction (STEMI). Medical coverage was classified in prepaid health insurance, social security insurance, PAMI and without medical coverage (except public coverage).
Results: Eighty percent of STEMI patients received reperfusion therapy, 75% by primary transluminal coronary angioplasty (PTCA). PTCA was more frequent in those with prepaid health insurance [OR 5.5 (2.5–12.4); p<0.001] and less frequent in PAMI patients [OR 0.47 (0.24–0.87), p=0.02] or in those without any medical coverage [OR=0.34 (0.2–0.6), p<0.001]. Thirteen percent of patients were transferred to another hospital, more frequently if they were PAMI patients (p=0.002). Time to PTCA was longer in PAMI patients [240 (88–370) min, p=0.0005] and shorter in patients with prepaid health insurance [80 (42–120) min, p<0.001]. Overall in-hospital STEMI mortality was 8%, 2.8% in patients with prepaid health insurance, 4.3% in patients with public medical coverage, 6.88% in patients with social security insurance and 25% in patients covered by PAMI (ANOVA <0.001). Mortality was significantly lower in patients with prepaid health insurance [OR=0.27 (0.08–0.91), p=0.035] and higher in PAMI patients, even after adjusting by sex, age and comorbidities [OR 2.40 (1.1–5.8), p=0.05].
Conclusion: STEMI treatment and mortality were different according to the type of medical coverage.