Abstract 4143739: Enhancing Care for Patients with ACS in Mexico: Impact of the Get With The Guidelines®-Coronary Artery Disease Mexico Project at the National Institute of Cardiology

Background: The GWTG initiative has improved global patient care. We introduced GWTG-CAD at Mexico’s largest referral center, the National Institute of Cardiology. This is an independent before/after quality analysis. Hypothesis: Implementing a standardized tool will improve ACS patient management and guideline-recommended therapies. Aims: To compare the center’s data before/after implementing the GWTG-CAD tool registry. Methods: Retrospective, comparative study of ACS patients either transferred from eight referring hospitals or arriving directly to our center. We compared two groups: admissions from July 2022-March 2023 ( before ) and April 2023-April 2024 ( after ). Continuous variables are presented as mean±standard deviation or median and interquartile range, based on their distribution. Data: A total of 473 patients, (202 in the before -period and 271 in the after -period). Age, gender, comorbidities and medical history were non-different between groups. The diagnoses included STEMI 73.2% vs. 58.1%, NSTEMI 23.3% vs. 38.8%, UA 3.4% vs. 2.9%. Symptom onset to first medical contact median time was 504(195-972 min) vs. 395(170-688 min), p=0.28. From the before -period, 32.2% underwent pPCI and 61.7% thrombolysis, vs. 46.2% and 42.9% in the after -period. Among all patients, the median time of arrival at referring hospital to PCI was 2,329(356-5142 min) during the before -period vs. 559(164-1702 min) in the after -period (p=0.002). Among STEMI transfers, the time of arrival at referring hospital to PCI was significantly lower (151[110-460] vs. 106[91-142] min, p=0.02). Among direct arrivals, door-to-balloon time was numerically, but not statistically lower (78.5[51-162] vs. 71[45-90] min, p=0.08). Prescription of guideline-recommended therapies from the before -period vs. after -period was DAPT (93.1% vs. 94.1%, p=0.68), ACEI/ARB (83.7% vs. 85.1%, p=0.68), BB (84.8% vs. 89.8%, p=0.10) and statins (97.3% vs. 95.3%, p=0.26). The overall survival rate was (95.5 vs. 97.4%). Conclusions: In this comparative study we observed a significant reduction of transfer to PCI times in all ACS patients after the implementation of the GWTG-CAD project. High prescription of guideline-recommended therapies at discharge were documented.