Abstract
Introduction: Coronary artery disease (CAD), with an estimated prevalence in Brazil in 2019 of approximately 2 cases per 100,000 inhabitants in the general population, reaching 14 cases per 100,000 in those over 70 years of age, is the leading cause of death, with 171,000 deaths in the same period, which corresponds to 12% of all deaths in the country, and is considered one of the diseases with the greatest clinical and financial impact in the world. Coronary angiography is commonly used to diagnose and define treatment in patients with acute myocardial infarction (AMI) with ST-segment elevation or with AMI without ST-segment elevation with a high risk of a new ischemic event. This exam aims to determine the degree of coronary artery involvement, in addition to establishing the presence and extent of myocardial damage. The prognosis of ACS is variable and in these high-risk patients, the invasive strategy can reduce new episodes of AMI, severe angina, and rehospitalization. This study aims to evaluate the distribution of coronary angiographies registered in the Outpatient Information System of the Unified Health System (SIA/SUS) by region of the country, as a surrogate for access to specialized health care in the SUS. Methods: A cross-sectional study was carried out with the number of coronary angiography procedures (SIGTAP procedure code: 02.11.02.00-10) registered by place of residence in the SIA/SUS, adjusted for the population of each region of Brazil, according to data from the Brazilian Institute of Geography and Statistics (IBGE) in 2022. Microsoft® Excel® 2019 (Version 2307) and R version 4.0 software were used and categorical variables were evaluated using the proportion test. Results: In 2022, 124,202 coronary angiography procedures were performed in Brazil. The Southeast region concentrates almost half of the procedures performed throughout the national territory (49.0%), however, when adjusted for population, the region that performed the most coronary angiographies proportionally was the South (80.53/100,000), followed by the Southeast (67.40/100,000), Central-West (53.22/100,000), Northeast (40.30/100,000) and North (33.39/100,000), resulting in a p-value of 0.0002. The greatest differences were observed between the South and Southeast regions, when compared with the North and Northeast regions, as shown in Table 1. Overall, Brazil performed an average of 57.81 coronary angiographies per 100,000 inhabitants during this period. Discussion and conclusions: The regional differences evidenced in this study in relation to care for patients with AMI can be observed in another study that showed that the age-standardized AMI mortality rate between 1996 and 2016 decreased by 44%, with significant regional differences, increasing in the North region by 5% and in the Northeast by 11%, and reducing in the Central-West region by 35%, in the Southeast by 68% and in the South by 85%, findings similar to this study, where the South and Southeast regions recorded 39% and 16% more procedures than the national average, while in the North and Northeast, 42% and 30% fewer were recorded. Access to the health system is vital for the diagnosis and treatment of coronary artery disease and the findings of this study suggest regional inequities in this process, in which regions with a higher human development index (HDI) recorded a greater number of coronary angiographies, such as the south and southeast regions, compared to regions with a lower HDI, such as the north and northeast regions, which recorded fewer exams than the national average.
