Clinical characteristics, medical management and outcomes of patients with ST-Elevation Myocardial Infarction in Sanglah General Hospital, Denpasar, Bali, Indonesia

Acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI), is a major health problem in Indonesia, including Bali. To evaluate clinical characteristics of ACS patients and the clinical outcome after reperfusion therapy for STEMI patients.This was a cross-sectional study using data from ACS 2016 registry in Bali. Subjects were consecutive adult ACS patients (minimum age of 18 years) who were hospitalized in Sanglah General Hospital (SGH), Denpasar, Bali Island. Diagnosis of ACS was established according to WHO criteria and was divided into unstable angina pectoris (UAP), non-STEMI, and STEMI. A total of 696 patients were enrolled; 75.7% of them were men. Patients' mean age was 58.3 ± 11.79 years. Diagnoses were 260 (37.4%) UAP, 161 (23.1%) non-STEMI, and 275 (39.5%) STEMI. Reperfusion therapy was given to 196 patients (71.3%), consisted of 86 (31.3%) fibrinolysis and 110 (40.0%) primary PCIs. The median time from onset to hospital admission was 6 hours. The median door-to-needle (DTN) time was 50 (10-295) minutes, while the median door-to-device (DTD) time was 144 (19-1028) minutes. Mortality rate was 8.2% in patients receiving fibrinolysis and 5.5% in patients underwent primary PCI. Mortality was associated with higher age, higher heart rate, lower blood pressures, higher serum creatinine levels, higher troponin T1 levels, higher GRACE, TIMI, and CRUSADE risk scores. Timely reperfusion for STEMI is still not achieved in most of the cases. Patients with high GRACE risk score or TIMI score had the highest risk of death. Door-to-device-time also tended to be longer in patients who died. Early recognition of ACS symptoms, pre-hospital transfer and emergency care in hospital should be improved in the future.