Clinico-demographical differences and seven years management performance of acute coronary syndrome in Bali, Indonesia

Background: The geographical diversity and clinical presentation differences of acute coronary syndrome (ACS) patients in Bali significantly influence the management performance and intervention outcomes. Bali, an island with varied geography, presents unique challenges for timely access to percutaneous coronary intervention (PCI) facilities, which are concentrated in South Bali. This study aims to describe annually the clinical characteristics of ACS patients in Bali, focusing on geographical factors and management performance. Methods: The regional data from the Indonesia Acute Coronary Syndrome Registry (One ACS) were utilized in this study. The study population consisted of patients aged over 18 years who were treated for ACS from 2017 to 2023 at Prof. Dr. I.G.N.G Ngoerah Central General Hospital in Denpasar, Bali. Several outcomes were described, including baseline characteristics, transfer time, door-to-balloon time (DTB), door-to-wire time (DTW), ambulance transport time, patient transport time, and major adverse cardiac event (MACE) outcomes. Results: A total of 4588 ACS patients based in Bali were included from 2017 to 2023. The majority of ACS patients originated from Denpasar city (44.1 %), followed by Badung (19.2 %) and Gianyar (8.5 %). More than half of the patients (57.9 %) were referred from primary healthcare, with a mean transfer time of 247.45 ± 698.26 min. Mortality rates were high, with significant numbers of cardiac arrests, heart failure, and cardiogenic shock. On multivariate analysis, shortness of breath, chest pain during light activity, patients seeking first medical contact (FMC) in Karangasem, and self-admission to the hospital were independently associated with mortality. Conclusions: The geographical challenges of Bali, particularly the limited distribution of PCI-capable facilities, contribute to delays in treatment and varied outcomes for ACS patients. Improvements in healthcare systems across Bali are required to conform with current guidelines and enhance intervention outcomes.