Reperfusion therapy of myocardial infarction in Mexico: A challenge for modern cardiology

Abstract

Mexico has been positioned as the country with the highest mortality attributed to myocardial infarction among the members of the Organization for Economic Cooperation and Development. This rate responds to multiple factors, including a low rate of reperfusion therapy and the absence of a coordinated system of care. Primary angioplasty is the reperfusion method recommended by the guidelines, but requires multiple conditions that are not reached at all times. Early pharmacological reperfusion of the culprit coronary artery and early coronary angiography (pharmacoinvasive strategy) can be the solution to the logistical problem that primary angioplasty rises. Several studies have demonstrated pharmacoinvasive strategy as effective and safe as primary angioplasty ST-elevation myocardial infarction, which is postulated as the choice to follow in communities where access to PPCI is limited. The Mexico City Government together with the National Institute of Cardiology have developed a pharmaco-invasive reperfusion treatment program to ensure effective and timely reperfusion in STEMI. The model comprises a network of care at all three levels of health, including a system for early pharmacological reperfusion in primary care centers, a digital telemedicine system, an inter-hospital transport network to ensure primary angioplasty or early percutaneous coronary intervention after fibrinolysis and a training program with certification of the health care personal. This program intends to reduce morbidity and mortality associated with myocardial infarction.

Reperfusion of myocardial infarction in India: Notions for México

“…The lack of a universal reperfusion program, an insufficient number of catheterization laboratories (available in only 15% of the hospitals, most of them not at all times), the fragmentation of the health care system and the poor capacity of primary care providers to properly recognize and initiate the management for STEMI may all contribute to this low rate of reperfusion. 13…”

Mortality following ischaemic stroke

“…The highest rates are in latvia, Hungary and Mexico, suggesting AMI patients do not always receive recommended care. In Mexico, the absence of a coordinated system of care between primary care and hospitals may have contributed to delays in repurfusion and low rates of angioplasty (Martínez-Sánchez, 2017). High rates of uncontrolled diabetes may also be a contributing factor in explaining the high AMI case-fatality rates (see indicator "Diabetes care" in Chapter 6) as patients with diabetes have worse outcomes after AMI compared to those without diabetes, particularly if the diabetes is poorly controlled.…”

Interinstitutional clinical practice guidelines for the treatment of acute myocardial infarction

“…2 Since 2014, the main public and private health services providers started implementing actions to improve AMI outcomes; 3 however, these measures are still far from being universal and patients living in marginalized areas do not receive timely treatment, and establishing regional care systems is therefore necessary. 4 Such is the case of the Mexican Institute of Social Security Código Infarto (Infarction Code) care protocol, which enables efficacious and efficient care to be provided 24 hours a day, 7 days a week (24/7) and all 365 days of the year. 5 These interinstitutional clinical practice guidelines for early diagnosis and timely treatment of ST-segment elevation acute myocardial infarction (STEMI) were developed with the purpose to establish critical pathways and essential inter-sectoral pharmacological strategies for the universal care of patients with AMI in Mexico.…”