Mortality in myocardial infarction remains high in Argentina: The association with health insurance coverage

• We observed high in-hospital mortality in myocardial infarction in Argentina.
• Treatments and outcomes were affected by insurance coverage.
• Patients with private insurance were treated more frequently with primary angioplasty in STEMI.
• Patients without private insurance had higher mortality.

ObjectivesThe present analysis included patients with myocardial infarction from the SCAR registry in Argentina. It reports how health insurance coverage influenced the outcomes.MethodsEighty-seven centers participated in a cross-sectional nation-wide multicenter survey.ResultsSeven hundred and fifty-eight patients were included, 476 (60.55%) with STEMI and 281(39.45%) non-STEMI (NSTEMI).In-hospital mortality was 7.35%. Mortality was independently associated with age (OR 1.06, CI95 1.02–1.1, p = 0.001), left ventricular dysfunction (OR 7.12, CI95 2.5–20, p < 0.001), and Killip 3–4 (OR 4.86, CI95 1.64–14,p = 0.004). Treatment with ACEi (OR 0.18, CI95 0.06–0.48, p < 0.005) and beta-blockers (OR 0.22, CI95 0.07–0.62, p = 0.05) was associated with lower mortality.In STEMI, the mean time from symptom onset to admission was 120 min (60–330) for patients arriving from home, and 240 min (120–510) for patients referred from other institutions. 285 patients underwent PCI with mean door-to-balloon time of 107 min (60–231); 92 patients received thrombolysis (mean door-to-needle time of 55 min (29–90)).Mortality in STEMI was 8%, which was independently associated with age (OR 1.09, CI95 1.04–1.14, p < 0.001), Killip 3–4 (OR 3, CI95 1.24–12.8, p = 0.02), and inotrope requirement (OR 19, CI95 6–60, p < 0.001). Door-to-balloon time < 90 min for primary PCI was independently associated with a significant reduction in mortality (OR 0.11, CI0.01–0.68, p = 0.001) in STEMI.We observed significant differences in the rate of PPCI and time to reperfusion according to the insurance coverage that might have influenced the outcomes.ConclusionsOutcomes in AMI were affected by insurance coverage. Efforts to improve reperfusion rates and delay to treatment are necessary.