Structure, Process, and Mortality Associated with Acute Coronary Syndrome Management in Guatemala’s National Healthcare System: The ACS-GT Registry

José Antonio Cornejo-Guerra; Magda Isabel Ramos-Castro; Mariana Gil-Salazar; Sofia Leal-Wittkowsky; Juan Carlos Santis-Mejía; Elisa María Anleu-De León; Oscar Fernando Castro-Alvarado; Boris Rudy Alexander López-Quiñónez; Edgar Alexander Illescas-González; Paola Overall-Salazar; Luis Antonio Rodríguez-Cifuentes; Karla Yesenia Miranda-Sandoval; Juan Pablo Pineda; Kevin Oneal Flores-Andrade; Roberto Antonio Pérez-Reyes; Sofía Waleska Girón-Blas; Josué Fernando Samayoa-Ruano

doi:10.5334/gh.1168

Structure, Process, and Mortality Associated with Acute Coronary Syndrome Management in Guatemala’s National Healthcare System: The ACS-GT Registry

Volume 17 (2022): Issue 1

By: José Antonio Cornejo-Guerra , Magda Isabel Ramos-Castro , Mariana Gil-Salazar , Sofia Leal-Wittkowsky , Juan Carlos Santis-Mejía , Elisa María Anleu-De León , Oscar Fernando Castro-Alvarado, Boris Rudy Alexander López-Quiñónez , Edgar Alexander Illescas-González, Paola Overall-Salazar, Luis Antonio Rodríguez-Cifuentes, Karla Yesenia Miranda-Sandoval , Juan Pablo Pineda , Kevin Oneal Flores-Andrade, Roberto Antonio Pérez-Reyes , Sofía Waleska Girón-Blas and Josué Fernando Samayoa-Ruano

Open Access

|Dec 2022

Figures & Tables

Table 1

Demographic and clinical characteristics.

	STEMI	NSTEMI/UA	TOTAL	P
	N = 88	N = 21	N = 109
	x̄ ± SD	x̄ ± SD	x̄ ± SD
Age ∼ years	60.9 ± 11.2	64.9 ± 12.6	61.6 ± 11.6	0.15
Weight ∼ kg	72.7 ± 10.4	70.6 ± 12.3	70.8 ± 14	0.43
	N (%)	N (%)	N (%)
Gender				0.25
Male	69 (78)	14 (66.7)	83 (68)
Housing				0.98
Rural	38 (43.2)	9 (42.9)	47 (43.1)
Educational level				0.43
Illiterate	11 (12.6)	4 (19)	15 (13.9)
Elementary school	37 (42.5)	12 (57.1)	49 (45.4)
High school	25 (28.7)	2 (9.5)	27 (25)
Technical degree	10 (11.5)	2 (9.5)	12 (11.1)
Bachelor’s degree or higher	4 (4.6)	1 (4.8)	5 (4.6)
Occupation				0.41
Informal commerce	19 (21.8)	8 (38.1)	27 (25)
Housewife	16 (18.4)	5 (23.8)	21 (19.4)
Unemployed	18 (20.7)	1 (4.8)	19 (17.6)
Technical	14 (16.1)	3 (14.3)	17 (15.7)
Professional	8 (9.2)	2 (9.5)	10 (9.3)
Agriculture	6 (6.9)	2 (9.5)	8 (7.4)
Formal commerce	6 (6.9)	0.0	6 (5.6)
Established hospital protocol for acute coronary syndrome	11 (12.5)	1 (4.8)	12 (11)	0.31
Medical history
Systemic hypertension	43 (48.9)	11 (52.4)	54 (49.5)	0.77
Diabetes mellitus	40 (45.5)	10 (47.6)	50 (45.9)	0.85
Smoking	24 (27.3)	3 (14.3)	27 (24.8)	0.22
Dyslipidaemia	19 (21.8)	2 (9.5)	21 (19.4)	0.2
Acute coronary syndrome	11 (12.6)	4 (19)	15 (13.9)	0.44
Other	20 (22)	6 (21)	26 (23)	0.62
Medication history
ACEI/ARB	34 (39.1)	9 (42.9)	43 (39.8)	0.75
Acetylsalicylic acid	7 (8)	5 (23.8)	12 (11.1)	0.03
Insulin	9 (10.3)	3 (14.3)	12 (11.1)	0.6
CCB	5 (5.7)	4 (19)	9 (8.3)	0.04
P2Y₁₂ inhibitor	5 (5.7)	1 (4.8)	6 (5.6)	0.86
β-blocker	5 (5.7)	1 (4.8)	6 (5.6)	0.86
Statins	3 (3.4)	2 (9.5)	5 (4.6)	0.24
Nitrites	1 (1.1)	1 (4.8)	2 (1.9)	0.27

[i] STEMI: ST-elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction, ACEI: Angiotensin-converting enzyme inhibitors, ARB: Angiotensin II receptor blocker, CCB: Calcium channel blocker.

Table 2

STEMI and NSTEMI individual characteristics.

STEMI CHARACTERISTICS	STEMI
	N = 88
	N (%)
Electrocardiographic location
Anterior	45 (51.1)
Inferior	38 (43.2)
Lateral	5 (5.7)
Reperfusion	52 (59.1)
Type of reperfusion
Fibrinolysis	52 (100)
Fibrinolytic
Alteplase	34 (65.4)
Streptokinase	17 (32.7)
Tenecteplase	1 (1.9) *
Reason PCI was not performed
No cardiac catherization laboratory	65 (73.9)
Time from symptom onset > 12 hours	13 (14.8)
Not considered by physician	7 (8)
Patient refused treatment	2 (2.3)
Hospital transfer not accepted	1 (1.1)
Reason fibrinolysis was not performed
Time from symptom onset > 12 hours	18 (50)
Not considered by physician	13 (36.1)
Lack of medical supplies	3 (8.3)
Contraindicated	1 (2.8)
Patient refused treatment	1 (2.8)
Angiography/PCI use in non-reperfused myocardial infarction	7 (19.4)
Ischaemia or viability evaluated prior to angiography/PCI in non-reperfused myocardial infarction	4 (57)
Treatment centre where fibrinolysis was performed
Public hospital (MSPAS)	44 (84.6)
Private hospital	7 (13.5)
Guatemalan social security institute (IGSS)	1 (1.9)
Successful fibrinolysis	34 (65.4)
Angiography/PCI after successful fibrinolysis	17 (50)
Within first 24 hours	0.0
After 24 hours	17 (100)
Cause of failed fibrinolysis
Both	6 (50)
Persistent ischaemia	5 (41.7)
Failure of ST segment descent	1 (8.3)
Rescue angioplasty	1 (14.3) *
NSTEMI/UA CHARACTERISTICS	NSTEMI/UA
	N = 21
	N (%)
Angiography/PCI performed	5 (23.8)
Diagnostic	4 (80)
PCI	1 (20)
	X̄± SD
Days until angiography/PCI was performed	6.4 ± 2.8
Electrocardiographic findings at admission
T-wave inversion	5 (29.4)
ST-segment depression	5 (29.4)
No alterations	4 (23.5)
ST-depression in more than 6 leads and ST-elevation in aVR	2 (11.8)
Left Bundle Branch Block	1 (5.9)
Crusade	35.8 ± 20.8

[i] * Performed at a private hospital (after the procedure patient was transferred back for treatment at public hospital).

STEMI: ST-elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction, PCI: percutaneous coronary intervention, MSPAS: “Ministerio de Salud Pública y Asistencia Social” (ministry of public health and social assistance), IGSS: “Instituto Guatemalteco de Seguridad social” (Guatemalan social security institute), UA: unstable angina.

Table 3

Clinical Presentation.

	STEMI	NSTEMI/UA	TOTAL	P
	N = 88	N = 21	N = 109
	x̄ ± SD	x̄ ± SD	x̄ ± SD
Heart rate ∼ Bpm	80.3 ± 24.9	91.4 ± 31.7	82.4 ± 26.5	0.08
GRACE	129 ± 32	109 ± 32	125 ± 32.7	0.01
	MEDIAN (25–75)	MEDIAN (25–75)	MEDIAN (25–75)
Systolic blood pressure ∼ mmHg	115 (91.2–134.7)	130 (110–140)	120 (100–139)	0.06
Oxygen saturation ∼ %	95 (91.7–97)	92 (86–96)	94 (90.2–97)	0.07
Diastolic blood pressure ∼ mmHg	70 (60–84.5)	80 (70–86)	70 (60–84)	0.22
Temperature ∼ °C	37 (36.5–37)	37 (36.7–37)	37 (36.5–37)	0.36
Respiratory rate ∼ Rpm	18 (16–22)	20 (17–24)	19 (16–22)	0.23
	N (%)	N (%)	N (%)
Typical angina	76 (86.4)	16 (76.2)	92 (84.4)	0.24
Dyspnoea	18 (20.5)	9 (42.9)	27 (24.8)	0.03
Atypical angina	8 (9.1)	1 (4.8)	9 (8.3)	0.51
Syncope	8 (9.1)	1 (4.8)	9 (8.3)	0.51
Cardiac arrest	1 (1.1)	0.0	1 (0.9)	0.62
Electrocardiographic findings at admission
Sinus rhythm	66 (75)	19 (90.5)	85 (78)	0.12
Third-degree AV block	14 (15.9)	0.0	14 (12.8)	0.05
Ventricular extrasystoles	4 (4.5)	1 (4.8)	5 (4.6)	0.96
Second-degree AV block	4 (4.5)	0.0	4 (3.7)	0.32
Other	2 (2.3)	1 (4.8)	3 (2.8)	0.53
Pacemaker rhythm	0.0	2 (9.5)	2 (1.8)	<0.01
Atrial fibrillation	1 (1.1)	0.0	1 (0.9)	0.62
First-degree AV block	1 (1.1)	0.0	1 (0.9)	0.62
Killip-Kimball				0.04
I	43 (48.9)	13 (61.9)	56 (51.4)
II	27 (30.7)	4 (19)	31 (28.4)
III	5 (5.7)	4 (19)	9 (8.3)
IV	13 (14.8)	0.0	13 (11.9)
TIMI				<0.01
0	0.0	2 (9.5)	2 (1.8)
1	3 (3.4)	2 (9.5)	5 (4.6)
2	8 (9.1)	6 (28.6)	14 (12.8)
3	11 (12.5)	8 (38)	19 (17.4)
4	9 (10)	2 (9.5)	11 (10)
5	12 (13.6)	0.0	12 (11)
6	8 (9.1)	1 (4.8)	9 (8.3)
≥7	37 (42)	0.0	37 (34)

[i] STEMI: ST-elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction, UA: unstable angina, Bpm: beats per minute, GRACE: Grace Risk Score, Rpm: respirations per minute, mmHg: millimetres of mercury, °C: degrees Celsius, AV: atrioventricular, Killip-Kimball: prognostic score in acute coronary syndrome evaluating the risk of death during the first 30 days, TIMI: score that assesses mortality, reinfarction or recurrent ischaemia during the first 14 days.

Table 4

Process and delay.

	STEMI	NSTEMI/UA	TOTAL	P
	N = 88	N = 21	N = 109
	x̄ ± SD	x̄ ± SD	x̄ ± SD
Prehospital delay
Time between ambulance call and arrival ∼ minutes*	18.4 ± 14.6	30 ± 23.7	20.7 ± 16.8	0.17
	MEDIAN (25–75)	MEDIAN (25–75)	MEDIAN (25–75)
Transfer time to FMC ∼ minutes	22.5 (20–38.7)	30 (12.5–60)	25 (17.5–42.5)	0.56
FMC ∼ minutes	300 (126.2–842.2)	185 (75–1035)	180 (74–465)	0.37
Transfer time from FMC to final treatment centre ∼minutes	30 (20–60)	120 (10–180)	80 (30–141)	0.46
	N (%)	N (%)	N (%)	P
Ambulance provided by				0.96
Public hospital (MSPAS)	11 (37.9)	1 (33.3)	12 (37.5)
Patient expense	8 (27.6)	1 (33.3)	9 (28.1)
Social security institute (IGSS)	8 (27.6)	1 (33.3)	9 (28.1)
Patient transport	2 (6.9)	0.0	2 (6.3)
Transfer destination
Public hospital (MSPAS)	24 (82.8)	3 (100)	27 (84.4)
Private hospital**	4 (13.8)	0.0	4 (12.5)
Social security institute (IGSS)	1 (3.4)	0.0	1 (3.1)
Reason for second transfer				<0.01
Elective PCI	8 (27.6)	1 (33.3)	9 (28.1)
Family request	3 (10.3)	0.0	3 (9.4)
Intensive care	2 (6.9)	0.0	2 (6.3)
Lack of physical space	0.0	1 (33.3)	1 (3.1)
Diagnostic approach	0.0	1 (33.3)	1 (3.1)
Fibrinolysis	11 (37.9)	–	–
Pharmaco-invasive strategy (after successful fibrinolysis)	3 (10.3)	–	–
Rescue PCI	2 (6.9)	–	–
Transfer characteristics
Performed by paramedic	14 (56)	2 (66.7)	16 (57.1)	0.9
Ambulance oxygen tank	15 (65.2)	1 (33.3)	16 (61.5)	0.34
Ambulance heart monitor	8 (34.8)	0.0	8 (30.8)	0.34
Ambulance defibrillator	5 (21.7)	0.0	5 (19.2)	0.53

[i] * Only applies if the patient was transferred by ambulance.

** Only applies to patients who were evaluated or treated at a private hospital and later referred to a public hospital. Patients who only received treatment at a private hospital were not included.

STEMI: ST-elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction, UA: unstable angina, FMC: first medical contact, PCI: percutaneous coronary intervention, MSPAS: “Ministerio de Salud Pública y Asistencia Social” (ministry of public health and social assistance), IGSS: “Instituto Guatemalteco de Seguridad social” (Guatemalan social security institute).

Table 5

STEMI–delay in definitive treatment: ACS-Gt registry vs. ESC guidelines.

	ACS-GT	ESC-STEMI	DIFFERENCE	P
	MEDIAN (25–75)
Time between ECG and STEMI diagnosis ∼ minutes	10 (5-20)	<10	0.0	0.44
Door to needle ∼ minutes	52.5 (27.7-71)	<10	+ 42	<0.01
Door-in to door-out ∼ minutes	120 (35-285)	<30	+ 90	<0.01
Total ischaemic time ∼ minutes	500 (388-720)	<120	+ 380	<0.01
	X̄ ± SD
Total ischaemic time (patients presenting <12 h) ∼ minutes	439.5 ± 139.6	<120	+ 319	<0.01
Time in which Angiography/PCI was performed after successful fibrinolysis ∼ hours*	205.1 ± 102.9	2-24	+ 181	<0.01

[i] * Pharmaco-invasive strategy refers to angiography or PCI in a period of 2-24 hours; in the present study, no patient met this criterion. STEMI: ST-elevation myocardial infarction, ACS-Gt: Acute coronary syndrome-Guatemala, ESC: European society of cardiology, ECG: electrocardiogram, PCI: percutaneous coronary intervention.

Table 6

Structure in the attention of the acute coronary syndrome.

	STEMI	NSTEMI/UA	TOTAL	P
	N = 88	N = 21	N = 109
	N (%)	N (%)	N (%)
Physician responsible				0.42
Internal medicine/emergency medicine resident	61 (69.3)	14 (66.7)	75 (68.8)
Internist	13 (14.8)	6 (28.6)	19 (17.4)
Cardiologist	6 (6.8)	1 (4.8)	7 (6.4)
General physician	6 (6.8)	0.0	6 (5.5)
Other	2 (2.3)	0.0	2 (1.8)
Availability
Fully working ambulance	87 (100)	21 (100)	108 (100)	–
Electrocardiogram	87 (98.9)	21 (100)	108 (99.1)	0.42
Hospital beds	87 (98.9)	21 (100)	108 (99.1)	0.64
Electrocardiogram paper	86 (97.7)	21 (100)	107 (98.2)	0.62
Any cardiac enzyme	80 (90.9)	15 (71.4)	95 (87.2)	0.01
Quantitative troponin	74 (84.1)	15 (71.4)	89 (81.7)	0.17
CKMB	73 (83)	12 (57.1)	85 (78)	0.01
Qualitative troponin	10 (11.4)	0.0	10 (9.2)	0.1
Any Fibrinolytic*	87 (98.9)	–	–	–
Streptokinase	86 (98.9)	–	–	–
Alteplase	63 (72.4)	–	–	–
Discharged with appointment (UNICAR)	8 (9.2)	2 (10)	10 (9.3)	0.78
	MEDIAN (25–75)	MEDIAN (25–75)	MEDIAN (25–75)
Days until appointment	20.5 (11.7–27)	7.5 (7–8)	17.7 (8–24)	0.05

[i] *During the data collection period, only streptokinase and alteplase was available in the National Ministry of Public Health network. STEMI: ST-elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction, UA: unstable angina, CKMB: creatin kinase-MB, UNICAR: “Unidad Nacional de Cirugía Cardiovascular” (Cardiovascular surgery unit of Guatemala).

Table 7

In-Hospital Medical Therapy.

MEDICATION	PRESCRIPTION				OPTIMAL MEDICAL THERAPY
	STEMI	NSTEMI/UA	TOTAL	P	STEMI	NSTEMI/UA	TOTAL	P
	N = 88	N = 21	N = 109		N = 88	N = 21	N = 109
	N (%)	N (%)	N (%)		N (%)	N (%)	N (%)
Aspirin	82 (95)	21 (100)	103 (97)	0.38	68 (83)	14 (67)	82 (80)	0.9
Clopidogrel	80 (94)	21 (100)	101 (95)	0.25	52 (66)	6 (29)	58 (58)	<0.01
Enoxaparin	18 (85)	18 (85)	83 (78)	0.35	31 (47)	9 (50)	40 (48)	0.86
Unfractionated Heparin	7 (82)	0.0	7 (6.6)	0.17	2 (28)	–	–	–
Fibrinolytic	52 (59)	–	–	–	41 (82)	–	–	–
Optimal In-Hospital Medical Therapy					6 (6.8)	3 (14.3)	9 (8.3)	0.26

[i] STEMI: ST-elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction, UA: unstable angina.

Table 8

Discharge Medical Therapy.

MEDICATION	DISCHARGE PRESCRIPTION – LVEF ≤40%				OPTIMAL MEDICAL THERAPY – LVEF ≤40%
	STEMI	NSTEMI/UA	TOTAL	P	STEMI	NSTEMI/UA	TOTAL	P
	N = 11	N = 3	N = 14		N = 11	N = 3	N = 14
	N (%)	N (%)	N (%)		N (%)	N (%)	N (%)
P2Y12 inhibitor	11 (100)	2 (66)	13 (92)	0.04	11 (100)	2 (100)	13 (100)	–
Statin	11 (100)	3 (100)	14 (100)	–	10 (90)	2 (100)	12 (92)	0.65
Aspirin	8 (72)	2 (66)	10 (71)	0.83	8 (100)	2 (100)	10 (100)	–
β-blocker	9 (81)	2 (66)	11 (78)	0.57	6 (100)	0.0	6 (85)	<0.01
ARNI	4 (36)	2 (66)	6 (42)	0.34	4 (100)	2 (100)	6 (100)	–
ACE inhibitor/ARB	6 (54)	1 (33)	7 (50)	0.51	5 (83)	0.0	5 (83)	<0.01
Discharged Optimal Medical Therapy					9 (81)	2 (66)	11 (78)	0.57
MEDICATION	DISCHARGE PRESCRIPTION – LVEF ≥40%				OPTIMAL MEDICAL THERAPY – LVEF ≥40%
	STEMI	NSTEMI/UA	TOTAL	P	STEMI	NSTEMI/UA	TOTAL	P
	N = 43	N = 5	N = 48		N = 43	N = 5	N = 48
	N (%)	N (%)	N (%)		N (%)	N (%)	N (%)
P2Y12 inhibitors	39 (95)	5 (100)	44 (95)	0.61	39 (100)	5 (100)	44 (100)	–
Aspirin	39 (95)	4 (80)	43 (93)	0.19	39 (100)	4 (100)	43 (100)	–
Statin	38 (92)	5 (100)	43 (93)	0.53	34 (82)	5 (100)	39 (84)	0.31
Discharged Optimal Medical Therapy					36 (83)	4 (80)	40 (83)	0.83

[i] LVEF: left ventricular ejection fraction, STEMI: ST-elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction, UA: unstable angina, OMT: optimal medical therapy.

Table 9

Outcome.

	STEMI	NSTEMI/UA	TOTAL	P
	N = 88	N = 21	N = 109
	N (%)	N (%)	N (%)
In-hospital mortality	16 (18.4)	6 (28.6)	22 (20.4)	0.29
Cause				0.76
Cardiogenic shock	9 (56.3)	2 (33.3)	11 (50)
Reinfarction	2 (12.5)	1 (16.7)	3 (13.6)
Stroke	1 (6.3)	1 (16.7)	2 (9.1)
Ventricular Arrythmias	1 (6.3)	0.0	1 (4.5)
Other non-specified	3 (18.8)	2 (33.3)	5 (22.7)
In-hospital mortality and reperfusion status
Non-reperfused	9 (25.7)	–	–	–
Reperfused	7 (13.5)	–	–	–
30-day mortality				0.38
Lost in follow-up	3 (4.6)	1 (7.7)	4 (5.1)
Deceased	1 (1.5)	1 (7.7)	2 (2.6)
In-hospital morbidity	46 (52.9)	8 (38.1)	54 (50)	0.22
Cause
Non-cardiovascular	35 (39.8)	8 (38.1)	43 (39.4)	0.88
Non-lethal ventricular arrythmia	4 (4.5)	1 (4.8)	5 (4.6)	0.96
Heart Failure	4 (4.5)	0.0	4 (3.7)	0.32
Non-lethal stroke	3 (3.4)	0.0	3 (2.8)	0.39
Haemorrhagic complication	3 (3.4)	0.0	3 (2.8)	0.39
Non-lethal reinfarction	3 (3.4)	0.0	3 (2.8)	0.39
Supraventricular Arrythmias	2 (2.3)	0.0	2 (1.8)	0.48
Reverted cardiac arrest	1 (1.1)	0.0	1 (0.9)	0.62
GUSTO classification
Severe	1 (33.3)	–	–	–
Mild	2 (66.7)	–	–	–
Cardiogenic shock	16 (18.2)	2 (9.5)	18 (16.5)	0.33
Pharmacotherapy				0.79
Both	13 (81.3)	2 (100)	15 (83.3)
Vasopressor	2 (12.5)	0.0	2 (11.1)
Inotropic	1 (6.3)	0.0	1 (5.6)
Echocardiogram previous to discharge	56 (63.6)	7 (33.3)	63 (57.8)	0.01
Performed by
Private clinic	52 (89.7)	7 (87.5)	59 (89.4)
National Ministry of Public Health	6 (10.3)	1 (12.5)	7 (10.6)
	X̄ ± SD	X̄ ± SD	X̄ ± SD
LVEF ∼ %	49.5 ± 9.3	42.1 ± 16.8	48.5 ± 10.6	0.06
	median (25–75)	median (25–75)	median (25–75)
In-hospital length of stay ∼ days	10 (6–14)	7 (4.5–9)	8 (4–14)	0.45

[i] STEMI: ST-elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction, UA: unstable angina, LVEF: left ventricular ejection fraction.

Mortality by type of ACS. STEMI: ST-elevation myocardial infarction, NSTEMI: non-ST elevation myocardial infarction [27, 28, 47, 49].

References

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Articles in this issue

DOI: https://doi.org/10.5334/gh.1168 | Journal eISSN: 2211-8179

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Language: English

Submitted on: Dec 16, 2021

Accepted on: Oct 5, 2022

Published on: Dec 1, 2022

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

acute coronary syndrome,

Guatemala,

ST elevation myocardial infarction,

non-ST elevated myocardial infarction,

fibrinolysis,

percutaneous coronary intervention

© 2022 José Antonio Cornejo-Guerra, Magda Isabel Ramos-Castro, Mariana Gil-Salazar, Sofia Leal-Wittkowsky, Juan Carlos Santis-Mejía, Elisa María Anleu-De León, Oscar Fernando Castro-Alvarado, Boris Rudy Alexander López-Quiñónez, Edgar Alexander Illescas-González, Paola Overall-Salazar, Luis Antonio Rodríguez-Cifuentes, Karla Yesenia Miranda-Sandoval, Juan Pablo Pineda, Kevin Oneal Flores-Andrade, Roberto Antonio Pérez-Reyes, Sofía Waleska Girón-Blas, Josué Fernando Samayoa-Ruano, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 17 (2022): Issue 1

Structure, Process, and Mortality Associated with Acute Coronary Syndrome Management in Guatemala’s National Healthcare System: The ACS-GT Registry

Figures & Tables

Figure 1

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

Table 7

Table 8

Table 9

Figure 2

Figure 3

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