TY - JOUR
T1 - Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country
T2 - an initial report of the extended Jakarta Acute Coronary Syndrome registry
AU - Dharma, Surya
AU - Andriantoro, Hananto
AU - Purnawan, Ismi
AU - Dakota, Iwan
AU - Basalamah, Faris
AU - Hartono, Beny
AU - Rasmin, Ronaly
AU - Isnanijah, Herawati
AU - Yamin, Muhammad
AU - Wijaya, Ika Prasetya
AU - Pratama, Vireza
AU - Gunawan, Tjatur Bagus
AU - Juwana, Yahya Berkahanto
AU - Suling, Frits R.W.
AU - Witjaksono, A. M.Onny
AU - Lasanudin, Hengkie F.
AU - Iskandarsyah, Kurniawan
AU - Priatna, Hardja
AU - Tedjasukmana, Pradana
AU - Wahyumandradi, Uki
AU - Kosasih, Adrianus
AU - Budhiarti, Imelda A.
AU - Pribadi, Wisnoe
AU - Wirianta, Jeffrey
AU - Lubiantoro, Utojo
AU - Pramesti, Rini
AU - Widowati, Diah Retno
AU - Aminda, Sissy Kartini
AU - Basalamah, M. Abas
AU - Rao, Sunil V.
N1 - Funding Information:
The authors thank all physicians and nurses at each participating health centres for their effort in completing the registry data. This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.
Publisher Copyright:
© 2016 BMJ Publishing Group. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Objective: We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. Design: Retrospective cohort study. Setting: Emergency department of 56 health centres. Participants: 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI. Main outcome measure: Characteristics of reperfusion therapy. Results: The majority of patients with STEMI (81%; N=826) were admitted to six academic percutaneous coronary intervention (PCI) centres. PCI centres received patients predominantly (56%; N=514) from a transfer process. The proportion of patients receiving acute reperfusion therapy was higher than non-reperfused patients (54% vs 46%, p<0.001), and primary PCI was the most common method of reperfusion (86%). The mean door-to-device (DTD) time was 102±68 min. In-hospital mortality of non-reperfused patients was higher than patients receiving primary PCI or fibrinolytic therapy (9.1% vs 3.2% vs 3.8%, p<0.001). Compared with non-academic PCI centres, patients with STEMI admitted to academic PCI centres who underwent primary PCI had shorter mean DTD time (96±44 min vs 140±151 min, p<0.001), higher use of manual thrombectomy (60.2% vs13.8%, p<0.001) and drug-eluting stent implantation (87% vs 69%, p=0.001), but had similar use of radial approach and intra-aortic balloon pump (55.7% vs 67.2%, and 2.2% vs 3.4%, respectively). In patients transferred for primary PCI, TIMI risk score ≥4 on presentation was associated with a prolonged door-in to door-out (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02). Conclusions: In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI-DO time along with improvement of DTD time at PCI centres. Trial registration number: NCT02319473.
AB - Objective: We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. Design: Retrospective cohort study. Setting: Emergency department of 56 health centres. Participants: 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI. Main outcome measure: Characteristics of reperfusion therapy. Results: The majority of patients with STEMI (81%; N=826) were admitted to six academic percutaneous coronary intervention (PCI) centres. PCI centres received patients predominantly (56%; N=514) from a transfer process. The proportion of patients receiving acute reperfusion therapy was higher than non-reperfused patients (54% vs 46%, p<0.001), and primary PCI was the most common method of reperfusion (86%). The mean door-to-device (DTD) time was 102±68 min. In-hospital mortality of non-reperfused patients was higher than patients receiving primary PCI or fibrinolytic therapy (9.1% vs 3.2% vs 3.8%, p<0.001). Compared with non-academic PCI centres, patients with STEMI admitted to academic PCI centres who underwent primary PCI had shorter mean DTD time (96±44 min vs 140±151 min, p<0.001), higher use of manual thrombectomy (60.2% vs13.8%, p<0.001) and drug-eluting stent implantation (87% vs 69%, p=0.001), but had similar use of radial approach and intra-aortic balloon pump (55.7% vs 67.2%, and 2.2% vs 3.4%, respectively). In patients transferred for primary PCI, TIMI risk score ≥4 on presentation was associated with a prolonged door-in to door-out (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02). Conclusions: In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI-DO time along with improvement of DTD time at PCI centres. Trial registration number: NCT02319473.
UR - http://www.scopus.com/inward/record.url?scp=85038955458&partnerID=8YFLogxK
U2 - 10.1136/BMJOPEN-2016-012193
DO - 10.1136/BMJOPEN-2016-012193
M3 - Article
C2 - 27580835
AN - SCOPUS:85038955458
SN - 2044-6055
VL - 6
JO - BMJ Open
JF - BMJ Open
IS - 8
M1 - e012193
ER -