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, M.
AU - Wijaya, Ika Prasetya
AU - Pratama, Vireza
AU - Gunarto, 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.
PY - 2016/8/31
Y1 - 2016/8/31
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
VL - 6
SP - e012193
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 8
ER -