<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2521-2281</journal-id>
<journal-title><![CDATA[Medicina clínica y social]]></journal-title>
<abbrev-journal-title><![CDATA[Med. clín. soc.]]></abbrev-journal-title>
<issn>2521-2281</issn>
<publisher>
<publisher-name><![CDATA[Facultad de Ciencias Médicas, Filial de Santa Rosa del Aguaray, Cátedra de Socioantropología]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2521-22812025000100220</article-id>
<article-id pub-id-type="doi">10.52379/mcs.v9.701</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Brecha de género en la reperfusión farmacológica y desenlaces del infarto agudo de miocardio con elevación del ST: cohorte Paraguaya 2019-2023]]></article-title>
<article-title xml:lang="en"><![CDATA[Gender gap in pharmacological reperfusion and outcomes of ST-elevation acute myocardial infarction: Paraguayan cohort 2019-2023]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ortellado Maidana]]></surname>
<given-names><![CDATA[José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González]]></surname>
<given-names><![CDATA[Graciela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gaona Figueredo]]></surname>
<given-names><![CDATA[Gabriel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rolón Ruiz Diaz]]></surname>
<given-names><![CDATA[Angel Ricardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ferreira Gaona]]></surname>
<given-names><![CDATA[Marta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Ministerio de Salud Pública y Bienestar Social Viceministerio de Rectoría y Vigilancia de la Salud ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Ministerio de Salud Pública y Bienestar Social Dirección General de Vigilancia de la Salud ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Ministerio de Salud Pública y Bienestar Social Dirección de Investigación y Publicaciones ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad Americana Escuela de Posgrado ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<volume>9</volume>
<numero>1</numero>
<fpage>220</fpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2521-22812025000100220&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2521-22812025000100220&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2521-22812025000100220&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  El infarto agudo de miocardio con elevación del ST (IAMCEST) es una de las principales causas de morbimortalidad cardiovascular. La reperfusión temprana mediante fibrinólisis sigue siendo esencial en países en desarrollo, aunque se han documentado inequidades de género en el acceso y los desenlaces. En Paraguay no existía un análisis nacional que evaluara estas diferencias.  Objetivo:  Evaluar la brecha de género en la reperfusión farmacológica y los desenlaces intrahospitalarios en pacientes con IAMCEST en Paraguay entre 2019 y 2023.  Metodología:  Estudio observacional, retrospectivo y multicéntrico basado en el registro nacional del Código IAM. Se incluyeron pacientes consecutivos con síndrome coronario agudo y se analizaron características clínicas, estrategias de reperfusión, tiempos críticos y desenlaces. Se aplicaron pruebas &#967;² y U de Mann-Whitney, con significancia en p&lt;0,05.  Resultados:  Se incluyeron 1.831 pacientes. Las mujeres fueron de mayor edad (65,6 ± 12,4 vs. 60,3 ± 11,4 años; p&lt;0,001) y presentaron más hipertensión, diabetes y obesidad, mientras que el tabaquismo y consumo de alcohol fueron más frecuentes en varones. La fibrinólisis se realizó en el 64,1 % de los casos, con menor proporción en mujeres (61,1 % vs. 66,2 %; p=0,048). Los tiempos críticos fueron mayores en mujeres: síntoma-puerta (310 vs. 280 min), puerta-aguja (50 vs. 40 min) e isquemia total (370 vs. 340 min; p&lt;0,001). La mortalidad intrahospitalaria fue superior en mujeres (12,4 % vs. 7,8 %; p&lt;0,001), al igual que la insuficiencia cardíaca (15,2 % vs. 10,5 %; p=0,01). No hubo diferencias en arritmias ventriculares, accidente cerebrovascular ni sangrado mayor.  Conclusión:  Las mujeres con IAMCEST en Paraguay presentan menor acceso a fibrinólisis, mayores retrasos y peor pronóstico intrahospitalario, lo que evidencia una brecha de género en la atención cardiovascular aguda.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  ST-elevation acute myocardial infarction (STEMI) is one of the leading causes of cardiovascular morbidity and mortality. Early reperfusion, mainly through fibrinolysis in developing countries, is essential to reduce complications and mortality. However, multiple international registries have documented gender inequities in access to reperfusion therapies, with greater delays and worse outcomes in women. In Paraguay, where fibrinolysis remains the most widely used strategy under the IAM Code, there had been no national analysis to assess these differences.  Objective:  To assess the gender gap in pharmacological reperfusion and in-hospital outcomes in patients with STEMI in Paraguay between 2019 and 2023.  Methodology:  Observational, retrospective, multicenter study based on the national registry of the IAM Code. Consecutive patients with acute coronary syndrome were included. Clinical characteristics, risk factors, reperfusion strategies, critical times, and in-hospital outcomes were analyzed using &#967;² and Mann-Whitney U tests, with significance set at p&lt;0.05.  Results:  A total of 1,831 patients were included. Women were older (65.6 ± 12.4 vs. 60.3 ± 11.4 years; p&lt;0.001) and had more hypertension, diabetes, and obesity, while smoking and alcohol consumption were more common in men. Fibrinolysis was performed in 64.1% of patients, less frequently in women than in men (61.1% vs. 66.2%; p=0.048). Critical times were longer in women: symptom-to-door (310 vs. 280 min), door-to-needle (50 vs. 40 min), and total ischemia (370 vs. 340 min; p&lt;0.001). In-hospital mortality was higher in women (12.4% vs. 7.8%; p&lt;0.001), as was heart failure (15.2% vs. 10.5%; p=0.01), while no significant sex differences were found in ventricular arrhythmias, stroke, or major bleeding.  Conclusion:  Women with STEMI in Paraguay have lower access to fibrinolysis, longer treatment delays, and worse in-hospital outcomes, confirming persistent gender inequities that require targeted health strategies.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Infarto del miocardio]]></kwd>
<kwd lng="es"><![CDATA[Reperfusión]]></kwd>
<kwd lng="es"><![CDATA[Equidad de género]]></kwd>
<kwd lng="en"><![CDATA[Myocardial infarction]]></kwd>
<kwd lng="en"><![CDATA[Reperfusion]]></kwd>
<kwd lng="en"><![CDATA[Gender equity]]></kwd>
</kwd-group>
</article-meta>
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