What is the clinical evidence from this study?

Study design: Observational. Population: Emergency myocardial infarction. Intervention: Primary percutaneous coronary intervention (pPCI) vs. Historical baseline (2008). Primary outcome: Population-adjusted in-hospital mortality (deaths per 100,000 population).

January 24, 2026Archives of Public Health1 citationsOpen Access

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

SASophia A. ArzumanovCreighton University ASAndrea Dias StephanusUniversidade Católica de Brasília JBJoaquim BarretoUniversidade Estadual de Campinas (UNICAMP)

Key Result

Despite a 190.94% increase in primary percutaneous coronary intervention hospitalizations and declining standardized costs, population-adjusted in-hospital mortality rose by 121.74% in Brazil from 2008 to 2023.

Study Design

Type

Observational

Structured PICO

Population

Nationwide retrospective observational study of emergency myocardial infarction hospitalizations treated with primary percutaneous coronary intervention in Brazil's public health system from 2008 to 2023.

Exposure

Primary percutaneous coronary intervention (pPCI) for emergency myocardial infarction

Outcome

Population-adjusted rates of pPCI, inflation-adjusted standardized costs, in-hospital mortality, and densities of registered pPCI-capable facilities

Despite a 190% increase in pPCI utilization and decreased inflation-adjusted costs in Brazil's public health system from 2008 to 2023, population-adjusted in-hospital mortality rose, highlighting persistent regional disparities and systemic challenges in timely care delivery.

Main Result

Absolute Event Rate: 0.51% vs 0.23%

Limitations

Analyses are restricted to Brazil's public system and may not generalize to the private sector.
The database is procedure-level rather than patient-level, limiting age- and sex-standardization and adjustments for comorbidities or socioeconomic status.
Limited visibility of pharmaco-invasive strategies and inability to quantify no-reperfusion cases.
Inability to isolate COVID-19 pandemic effects on access, allocation, and outcomes.

Abstract

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.

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