STEMI Management and Outcomes at a Regional Hospital in Guatemala
type: CreativeWork
description: BACKGROUND: ST-elevation myocardial infarction (STEMI) is a leading cause of cardiovascular mortality worldwide, with a growing burden in low- and middle-income countries (LMICs). In Guatemala, in-hospital mortality from acute coronary syndromes markedly exceeds global averages due to delayed presentation, limited reperfusion access, and systemic resource constraints. Hospital Nacional de San Benito (HNSB), the main public referral hospital for rural Petén, operates without percutaneous coronary intervention (PCI) and with severely restricted fibrinolytic supply, providing a critical setting to examine evidence-practice gaps in STEMI care. METHODS: A retrospective chart review was conducted of all adults (≥18 years) with ECG-confirmed STEMI presenting to HNSB between January 2019 and April 2025. Patients with revised non‑STEMI diagnoses or insufficient documentation were excluded. Demographic, clinical, geographic, and process‑of‑care variables were abstracted from paper medical records using a standardized form. The primary outcome was in‑hospital mortality. Survivors and non‑survivors were compared using chi‑square or Fisher's exact tests for categorical variables and two‑sample or Welch's t‑tests for continuous variables. RESULTS: Of 112 patients, 62 (55.4%) survived to discharge and 50 (44.6%) died in‑hospital. Mortality was numerically higher among women, older patients, and those residing farther from HNSB, though these differences did not reach statistical significance. Documented dyslipidemia and diabetes were highly prevalent overall and more often recorded in survivors (92.0% vs 70.0%, p < 0.023 and 87.2% vs 53.3%, p < 0.001, respectively, while prior TIA/stroke showed a trend toward higher prevalence in non‑survivors (34.45% vs 11.5%, p = 0.035), patterns suggesting substantial documentation and survivorship bias rather than true protective effects of chronic conditions. Overall, care‑process intervals and treatment patterns revealed large deviations from…
abstract: BACKGROUND: ST-elevation myocardial infarction (STEMI) is a leading cause of cardiovascular mortality worldwide, with a growing burden in low- and middle-income countries (LMICs). In Guatemala, in-hospital mortality from acute coronary syndromes markedly exceeds global averages due to delayed presentation, limited reperfusion access, and systemic resource constraints. Hospital Nacional de San Benito (HNSB), the main public referral hospital for rural Petén, operates without percutaneous coronary intervention (PCI) and with severely restricted fibrinolytic supply, providing a critical setting to examine evidence-practice gaps in STEMI care. METHODS: A retrospective chart review was conducted of all adults (≥18 years) with ECG-confirmed STEMI presenting to HNSB between January 2019 and April 2025. Patients with revised non‑STEMI diagnoses or insufficient documentation were excluded. Demographic, clinical, geographic, and process‑of‑care variables were abstracted from paper medical records using a standardized form. The primary outcome was in‑hospital mortality. Survivors and non‑survivors were compared using chi‑square or Fisher's exact tests for categorical variables and two‑sample or Welch's t‑tests for continuous variables. RESULTS: Of 112 patients, 62 (55.4%) survived to discharge and 50 (44.6%) died in‑hospital. Mortality was numerically higher among women, older patients, and those residing farther from HNSB, though these differences did not reach statistical significance. Documented dyslipidemia and diabetes were highly prevalent overall and more often recorded in survivors (92.0% vs 70.0%, p < 0.023 and 87.2% vs 53.3%, p < 0.001, respectively, while prior TIA/stroke showed a trend toward higher prevalence in non‑survivors (34.45% vs 11.5%, p = 0.035), patterns suggesting substantial documentation and survivorship bias rather than true protective effects of chronic conditions. Overall, care‑process intervals and treatment patterns revealed large deviations from…
author: Reyna, Tanya Rachelle
language: en
keywords: Guatemala, Hospital Mortality, Myocardial Infarction, Quality of Health Care, ST Elevation Myocardial Infarction, Thrombolytic Therapy, Time-to-Treatment
date published: 2026-06-15T19:55:31Z
date modified: 2026-07-24T05:52:36Z
provider: University of Texas Southwestern Medical Center
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Texas Southwestern Medical Center

PropertyValue
property ID: Handle
value: https://hdl.handle.net/2152.5/10840