• Surya Dharma, Hananto Andriantoro, Ismi Purnawan, Iwan Dakota, Faris Basalamah, Beny Hartono, Ronaly Rasmin, Herawati Isnanijah, Muhammad Yamin, Ika Prasetya Wijaya, Vireza Pratama, Tjatur Bagus Gunarto, Yahya Berkahanto Juwana, Frits R W Suling, A M Onny Witjaksono, Hengkie F Lasanudin, Kurniawan Iskandarsyah, Hardja Priatna, Pradana Tedjasukmana, Uki Wahyumandradi, Adrianus Kosasih, Imelda A Budhiarti, Wisnoe Pribadi, Jeffrey Wirianta, Utojo Lubiantoro, Rini Pramesti, Diah Retno Widowati, Sissy Kartini Aminda, M Abas Basalamah, and Sunil V Rao.
• Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
• BMJ Open. 2016 Aug 31; 6 (8): e012193.

ObjectiveWe 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.DesignRetrospective cohort study.SettingEmergency department of 56 health centres.Participants3015 patients with acute coronary syndrome, of which 1024 patients had STEMI.Main Outcome MeasureCharacteristics of reperfusion therapy.ResultsThe 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).ConclusionsIn 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 NumberNCT02319473.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

27 keywords...

hide…