BackgroundThere is a scarcity of knowledge as to whether rates of myocardial reperfusion use and 30‐day mortality for patients with ST‐segment–elevation myocardial infarction are similar among patients using the Brazilian Public Health System (SUS) and those using the private healthcare system.Methods and ResultsA total of 707 patients were analyzed using the VICTIM (Via Crucis for the Treatment of Myocardial Infarction) register database; 589 patients from the SUS and 118 from the private network with ST‐segment–elevation myocardial infarction, who attended hospitals with the capacity to perform primary percutaneous coronary intervention (PCI) were investigated. The timeline, rates of use of PCI, and the 30‐day probability of death were investigated, comparing the SUS patients to those in the private system. The mean time between symptom onset and arrival at the PCI hospital was higher for SUS patients compared with users of the private system (25.4±36.5 versus 9.0±21 hours; P<0.001, respectively). Rates of primary PCI were low in both groups, but significantly lower for the SUS patients (45% versus 78%; P<0.001). The 30‐day mortality rate of SUS patients was 11.9% and of private patients was 5.9% (P=0.04). In the fully adjusted model, the odds ratio for 30‐day mortality for the SUS patients was higher (odds ratio, 2.96; 95% CI, 1.15–7.61; P=0.02).ConclusionsThe delay in reaching a PCI hospital was almost 3 times higher for the SUS patients. Primary PCI was underused in both groups, especially in the SUS patients. The SUS patients were more likely to die during the 30‐day follow‐up.

With regard to discrepancies in the cardiologic assistance, gender differences within predictive models are usually taken as ‘disparities’. However, such differences should be further scrutinised. We aimed to apply the Blinder–Oaxaca method in order to investigate potential sex-related disparities in the time from onset of symptoms to upscale assistance in ST-segment elevation myocardial infarction (STEMI) patients transferred to referential hospitals. All public and private hospitals with 24/7 PCI facilities in the state were included, and 1077 STEMI individuals were prospectively enrolled. We applied the Blinder–Oaxaca decomposition for the predictive model. The study included socioeconomic, clinical and geographic predictors. In ‘crude’ comparison under Student’s t-test, the logarithm of the total time was longer for female than male, reaching a difference of 0.22. In the Blinder–Oaxaca adjusted model, women presented higher total time than men. The total difference was 0.248 (95% CI = 0.051–0.445; p = 0.012), mostly related to the ‘explained’ portion, and the ‘unexplained’ portion reached a tiny fraction of the decomposition of elements, not significantly different from zero. There was no relevant unexplained fraction, also known as discrimination. Hence, the differences are attributable to the influence of the predictors as well as the contrafactual endowments for each sex.