Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry

Dharma, Surya and Andriantoro, Hananto and Purnawan, Ismi and Dakota, Iwan and Basalamah, Faris and Hartono, Beny and Rasmin, Ronaly and Isnanijah, Herawati and Yamin, Muhammad and Wijaya, Ika Prasetya and Pratama, Vireza and Gunawan, Tjatur Bagus and Juwana, Yahya Berkahanto and Suling, Frits R.W and Witjaksono, A M Onny and Lasanudin, Hengkie F and Iskandarsyah, Kurniawan and Priatna, Hardja and Tedjasukmana, Pradana and Wahyumandradi, Uki and Kosasih, Adrianus and Budhiarti, Imelda A and Pribadi, Wisnoe and Wirianta, Jeffrey and Lubiantoro, Utojo and Pramesti, Rini and Widowati, Diah Retno and Aminda, Sissy Kartini and Basalamah, M Abas and Rao, Sunil V (2016) Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry. BMJ Open. pp. 1-10.

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Abstract

Objective: We 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. Design: Retrospective cohort study. Setting: Emergency department of 56 health centres. Participants: 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI. Main outcome measure: Characteristics of reperfusion therapy. Results: The 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 nonreperfused 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 nonreperfused 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 intraaortic 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 doorout (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02). Conclusions: In 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 number: NCT02319473.

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