Trends in reperfusion therapy for acute ST-segment elevation myocardial infarction in an academic PCI centre in the metropolitan area of a developing country

Background
Long-term reports on reperfusion therapy for acute ST-segment elevation myocardial infarction (STEMI) in developing countries are scarce.

Purpose
We reported changes in acute reperfusion therapy for STEMI that have been observed over time in an academic tertiary care percutaneous coronary intervention (PCI) centre that hosting a STEMI network in the large metropolitan area of Jakarta, Indonesia since 2010 and covering around 11 million inhabitants.

Methods
A retrospective analysis was performed in 6336 patients with STEMI who admitted to the emergency department of a PCI centre in 2008 (before STEMI network introduction), and during 2011 to 2018.

Results
Among STEMI patients admitted during 2011–2018 (mean age: 56±10 years, 86% male), 57.6% had anterior wall myocardial infarction, and 71.3% presented with Killip classification I. Compared with the period 2011–2014 (N=2766), patients who were admitted in the period 2015–2018 (N=3250) were receiving more primary percutaneous coronary intervention (PCI) (61.6% vs. 44.2%, P<0.001) with shorter door-to-device time (median 72 min versus 97 min, P<0.001), and less in-hospital fibrinolytic therapy (2.7% vs. 4.8%, P<0.001). The percentage of STEMI patients who did not receive reperfusion treatment decreased from 51% to 35.5% (P<0.001). In-hospital mortality declined from 10% in 2008 (before the STEMI network was initiated) and 8% in 2011 to 6.4% in 2018 (P for trends = 0.05). Multivariable analysis showed that primary PCI was significantly associated with better in-hospital survival (adjusted odds ratio, 0.52; 95% confidence interval, 0.42 to 0.65, P<0.001).

Conclusion
The data indicate that the introduction of a STEMI network resulted in more patients receiving timely primary PCI and lower early mortality rates in recent years.