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. 2015 May 21;2(1):e000240.
doi: 10.1136/openhrt-2015-000240. eCollection 2015.

Organisation of reperfusion therapy for STEMI in a developing country

Surya Dharma  1 , Hananto Andriantoro  1 , Iwan Dakota  1 , Ismi Purnawan  2 , Vireza Pratama  3 , Herawati Isnanijah  4 , Muhammad Yamin  5 , Tjatur Bagus  6 , Benny Hartono  7 , Endang Ratnaningsih  8 , Frits Suling  9 , M Abas Basalamah  10
Affiliations

Organisation of reperfusion therapy for STEMI in a developing country

Surya Dharma et al. Open Heart. .

Abstract

Objective: Routine evaluation of performance measures for the system of care for patients with ST-elevation myocardial infarction (STEMI) is needed to improve the STEMI network. We sought to evaluate the current status of reperfusion therapy for STEMI in the capital city of a developing country where a STEMI network was introduced in 2010.

Methods: Data were obtained from a local registry. A total of 28 812 patients admitted to the emergency department of a national cardiovascular hospital in three different periods (2007, 2010 and 2013) were retrospectively analysed; there were 2703 patients with STEMI.

Results: In 2013 compared with 2007, there was a major increase in the number of primary percutaneous coronary interventions (PCIs) (35% vs 24%, p<0.001), and the proportion of non-reperfused patients fell (62.8% vs 67.7%, p<0.001). An improvement in the overall STEMI mortality rate was also observed (7.5% vs 11.7%, p<0.001).

Conclusions: Implementation of a regional system of care for STEMI may improve utilisation of primary PCI. Future organisation of reperfusion therapy in a developing country such as Indonesia strongly calls for a strategy that focuses on prehospital care to minimise delay from the first medical contact to reperfusion therapy, and this may reduce the proportion of non-reperfused patients. These strategies are in concordance with guideline recommendations and may reduce or eliminate gaps in healthcare in developing countries, particularly the underutilisation of evidence-based therapies for patients with STEMI.

Trial registration number: NCT 02319473, Clinicaltrials.gov.

Trial registration: ClinicalTrials.gov NCT02319473.

Keywords: CORONARY ARTERY DISEASE.

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Figures

Figure 1
Figure 1
Patient distribution of the study population. ACS, acute coronary syndrome; ED, emergency department; Non-STE ACS, non-ST-elevation acute coronary syndrome; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.
Figure 2
Figure 2
Characteristics of reperfusion therapy for ST-elevation myocardial infarction (STEMI) patients in 2007, 2010 and 2013. PCI, percutaneous coronary intervention. *p Values given are based on differences between 2007 and 2013.
Figure 3
Figure 3
Flow chart of the Jakarta Cardiovascular Care Unit (CCU) Network System. There are four methods of ECG transmission to the Heart Line: faximile system, email, blackberry messenger and WhatsApp. After an ST-elevation myocardial infarction (STEMI) case has been identified by the cardiologist on duty at the Heart Line and the patient needs reperfusion therapy, the call centre staff will send an ambulance to transfer the patient to the nearest percutaneous coronary intervention (PCI) centre. BBM PIN, blackberry messenger personal identification number.
Figure 4
Figure 4
Future ST-elevation myocardial infarction (STEMI) network programme in Jakarta.
See this image and copyright information in PMC

References

    1. Kolansky DM. Acute coronary syndromes: morbidity, mortality and pharmacoeconomic burden. Am J Manag Care 2009;15:S36–41. - PubMed
    1. Lloyd-Jones D, Adams R, Carnethon M et al. Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009;119:480–6. 10.1161/CIRCULATIONAHA.108.191259 - DOI - PubMed
    1. Rajagopal V, Bhatt DL. Acute coronary syndrome statistics: what you don't see can hurt you. Am Heart J 2005;149:955–6. 10.1016/j.ahj.2005.01.025 - DOI - PubMed
    1. Steg PG, James SK, Atar D et al. , Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC guidelines for the management of acute myocardial infarction in patients presenting with ST segment elevation. Eur Heart J 2012;33:2569–619. 10.1093/eurheartj/ehs215 - DOI - PubMed
    1. O'Gara PT, Kushner FG, Ascheim DD et al. , Zhao DXCF/AHA Task Force. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013;127:529–55. 10.1161/CIR.0b013e3182742c84 - DOI - PubMed

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