Introduction:

fibrinolytic (FBL) treatment in ST-Elevation Myocardial Infarction (STEMI) has been performed in Uruguay for more than 30 years. Considering that access to primary angioplasty is restricted to Montevideo, FBL remain the reperfusion method for many patients. Since 2011, Fondo Nacional de Recursos (FNR) offers the financial coverage of the FBL treatment. There is limited updated information on the use of FBL in our country.

Objective:

to know the current state of the use of FBL treatment under FNR coverage, the care process and the results obtained with it.

Method:

retrospective, observational study analyzing a cohort of patients with STEMI who were administered FBL funded by the FNR between 1st July 2011 and 30th June 2015. Demographic factors, health care coverage, clinical features, treatment times, clinical signs of reperfusion, cineangiocoronariography (CACG), adjuvant treatment, intrahospital complications and mortality, were studied anonymously.

Results:

were included 841 patients with STEMI who were treated with FBL. The mean age was 62,6 years (range 23-95 years), 74,2% were male. Public health care coverage 23.5% and private 76.5%. Streptokinase (SK) was used in 52,9% and tenecteplase (TNK) in 47,1%. The mean time between the onset of symptoms and the first medical contact (FMC) was 128 min. The mean time between FMC and emergency admission was 78 minutes and door to needle time was 77 minutes. Montevideo and three nearby departments presented the lowest rates of FBL use, 97.2% were treated in another city outside the capital. The 54,1% had electrocardiographic reperfusion criteria at 90 minutes. Central nervous system bleeding occurred in 0,8%, digestive bleeding in 0.5% and other bleeds requiring transfusion in 0.6%. On the first day, CACG was performed in 37,8% of the patients (32,8% in the SK group and 43,5% in the TNK group, p = 0,001), and at 30 days in 64,9% (60,6% % Of SK group and 69,7% of TNK group, p = 0,002). Mortality on the first day was 5,1%, at 30 days 10.9% and 14,3% at the year, with no significant difference between those treated with SK or TNK.

Conclusions:

the FBL use rate at STEMI in Uruguay is low and approximately half is done under FNR coverage. There are regional differences and inequity according to health care coverage. Treatment times are prolonged and far from international guidelines. CACG was performed within 30 days in almost two thirds of patients, but only 37,8% in the first 24 hours. Mortality in this series is comparable with international registries.

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