Acute myocardial infarction in a second-level unit

Acute myocardial infarction is one of the most frequent causes of admittance and the first cause of death in an intensive care unit from a second-level hospital where the infrastructure, installed capacity and location withheld access to optimal reperfusion treatment.

To evaluate mortality, length of stay, complications and mechanical ventilation requirement in patients with myocardial infarction who underwent fibrinolysis against those who did not.

Observational, retrospective and analytic study. Patients admitted to the intensive care unit with ST elevated acute myocardial infarction from October 2008 to September 2018 were included. Reperfusion strategy, time to first attention, cardiovascular and non-cardiovascular complications, as well as outcome were evaluated.

244 patients were included with mean age of 59.1 ± 10.7 years and high prevalence of obesity, diabetes and hypertension. 183 patients underwent fibrinolysis. Time to treatment was shorter in those thrombolyzed (5.9 ± 5.8 vs. 20.4 ± 11.0 hours; p < 0.0001), with less requirement of mechanical ventilation (26.2 vs. 52.4%; p = 0.002), less intensive care stay (3.0 ± 2.6 vs. 4.6 ± 4.8 days; p = 0.029), less frequency of complications, and significant difference in death (16.3 vs. 50.8%, p < 0.0001).

Fibrinolysis diminished the risk of death, mechanical ventilation requirement, length of stay and cardiovascular and non-cardiovascular complications.