ACS Management in Low-Resource Settings. ARMANDO GARCIA-CASTILLO MD FACC Director Cardiolink Clin Trials Governor Elected ACC Chapter MEXICO
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1 ACS Management in Low-Resource Settings ARMANDO GARCIA-CASTILLO MD FACC Director Cardiolink Clin Trials Governor Elected ACC Chapter MEXICO
2 DISCLOSURE ( last 12 months) Categories of potential conflict of interest Company Sponsoring of transport and/or hotel accommodations in Congresses Sponsored in clinical trials and/or in basic research funded by pharmaceutical companies Speaker in meetings sponsored by pharmaceutical companies Participate in normative committees of scientific trials sponsored by pharmaceutical companies Receive institutional support from pharmaceutical companies Writing of educative materials sponsored by pharmaceutical companies Hold stocks from pharmaceutical companies SANOFI, Pfizer AstraZeneca, MSD, Servier, Medtronico, Boston Sci, Abbot Vascular SANOFI, AZ, Daichi, Esai SANOFI, AZ, Pfizer, MSD, Abbot SANOFI,, Daichi, Esai -- BI, MSD, Pfizer, Sanofi
3 TEACHING POINTS Fighting against the same Enemy but in two diferent worlds Evolution in ACS treatment in México Challenges to improve the approach & treatment in ACS in México
4 TEACHING POINTS Fighting against the same Enemy but in two diferent worlds Evolution in ACS treatment in México Challenges to improve the approach & treatment in ACS in México
5
6 Total Health Expenditure, % of GDP
7 Total Health Expenditure, % of GDP / Billions Dlls 2,885 billions/dlls 131 billions/dlls
8 Total Health Expenditure, Per Capita (USD/PPP) 8,713 USD/PPP 1,024 USD/PPP
9 1,442 billions/dlls 69 billions/dlls
10 360 billions/dlls 37 billions/dlls
11 CATH LABS in U.S. and MEXICO Total 2, cath lab/million people Total cath lab/million people James R. Langabeer et al. J Am Heart Assoc 2013;2:e REMIE: Registro Mexicano de Interv. Endovasculares
12 TEACHING POINTS Fighting against the same Enemy but in two diferent worlds Evolution in ACS treatment in México Challenges to improve the aproach&treatment in ACS in México
13 Lupi Herrera Eulo Arch Cardiol Mex 2002:72 García Castillo Armando. Arch Cardiol Mex 2005:75 Martínez Sanchez Carlos Arch Cardiol Mex 2016:86
14 STEMI: Reperfusion Therapy n = 4,253 n = 8,600 n = 8,296 % Lupi Herrera E, The RENASICA Cooperative Group. National Registry of Acute Ischemic Coronary Syndromes (RENASICA).. Arch Cardiol Mex. 2002;72: S Garcia-Castillo A, et al. RENASICA 2 Mexican Registry of Acute Coronary Syndromes. Arch Cardiol Mex. 2005;75:S6-32 Martinez Sanchez et al. RENASICA 3 Mexican Registry of Acute Coronary
15 STEMI: Mortality n = 4,253 n = 8,600 n = 8,296 % Lupi Herrera E, The RENASICA Cooperative Group. National Registry of Acute Ischemic Coronary Syndromes (RENASICA).. Arch Cardiol Mex. 2002;72: S Garcia-Castillo A, et al. RENASICA 2 Mexican Registry of Acute Coronary Syndromes. Arch Cardiol Mex. 2005;75:S6-32 Martinez Sanchez et al. RENASICA 3 Mexican Registry of Acute Coronary
16 UA/NSTEMI: Early Invasive Strategy/PCI n = 4,253 n = 8,600 n = 8,296 % Lupi Herrera E, The RENASICA Cooperative Group. National Registry of Acute Ischemic Coronary Syndromes (RENASICA).. Arch Cardiol Mex. 2002;72: S Garcia-Castillo A, et al. RENASICA 2 Mexican Registry of Acute Coronary Syndromes. Arch Cardiol Mex. 2005;75:S6-32 Martinez Sanchez et al. RENASICA 3 Mexican Registry of Acute Coronary
17 UA/NSTEMI: Mortality n = 4,253 n = 8,600 n = 8,296 % Lupi Herrera E, The RENASICA Cooperative Group. National Registry of Acute Ischemic Coronary Syndromes (RENASICA).. Arch Cardiol Mex. 2002;72: S Garcia-Castillo A, et al. RENASICA 2 Mexican Registry of Acute Coronary Syndromes. Arch Cardiol Mex. 2005;75:S6-32 Martinez Sanchez et al. RENASICA 3 Mexican Registry of Acute Coronary
18 Approach & Outcomes RENASICA III ACCESS GRACE CRUSADE (n = 8,296) (n = 12,068) (n = 102,341) (n = 180,842) Lytic Therapy (%) Primary PCI (%) Reperfusion Therapy (%) Cath (%) PCI (%) CABG (%) Death STEMI (%) Death UA/NSTEMI (%) Arch Arch Cardiol Cardiol Mex Mex 2005; 2016;86: : Supl I NEJM 1998;339: JAMA 2007;297: JAMA 2004:292:45-54 CRUSADE
19 TEACHING POINTS Fighting against the same Enemy but in two diferent worlds Evolution in ACS treatment in México Challenges to improve the approach & treatment in ACS in México
20 CARDIOVASCULAR BURDEN: OACD Data DISEASES Diabetes in people years Rate per 100 thousand people MORTALITY Acute Myocardial Infarction Obesity Ischemic Cerebrovascular Infarction Men Smokers Hemorragic Cerebrovascular Infarction
21 5 Tasks Pending 1.- Increase the Public Health Expenditure from 6% to 10% of GDP 2.- Implementation of Chest Pain Center Programs in the country 3.- Increase the number of Hospitals with Cath Lab facilities 4.- Implementation of the Codigo Infarto Project 5.- Develop Reperfusion Regional Networks in the country 6.- Avoid Fragmentation in Health Care System
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