A contemporary overview of emergency myocardial infarction hospitalizations with primary percutaneous coronary intervention in Brazil: regional trends of costs and outcomes

BACKGROUND: Primary percutaneous coronary intervention (pPCI) is the gold standard treatment for acute myocardial infarction (MI). Yet, its implementation across Brazil's diverse regions remains poorly characterized. Although Brazil's public healthcare system (Sistema Único de Saúde [SUS]) serves approximately 72% of Brazil's population, comprehensive analysis of pPCI utilization patterns and outcomes has been limited. This study aimed to evaluate contemporary trends in pPCI utilization, associated costs, and clinical outcomes across Brazil's regions from 2008 to 2023. METHODS: We conducted a retrospective observational study of emergency MI hospitalizations treated with pPCI using Brazil's Unified Health System databases. Population‑adjusted rates of pPCI, inflation‑adjusted standardized costs, in‑hospital mortality, and densities of registered pPCI‑capable facilities were estimated for Brazil and its five regions. Five‑year interval means and cumulative changes were computed. Statistical significance was evaluated with Z‑tests and 95% confidence intervals. RESULTS: National pPCI hospitalizations increased by 190.94%, with marked regional variation. The South reached 26.22 procedures per 100,000 population in 2023, while the North remained critically low (1.49 per 100,000). After inflation adjustment, standardized costs declined nationally (-36.34% per day; -47.12% per hospitalization), yet population‑adjusted in‑hospital mortality rose by 121.74% over the study period. Across regions, most pPCI‑capable facilities were private rather than public or philanthropic. Disparities were most pronounced between the South and North regions, reflecting broader socioeconomic inequities. CONCLUSION: Brazil has substantially increased pPCI utilization, but persistent regional disparities and rising population‑adjusted mortality highlight systemic challenges in timely, high‑quality care. Targeted interventions - standardized protocols, strengthened infrastructure and transfer networks in underserved areas, and focused investment - are needed to improve equity and cardiovascular outcomes nationwide.