Organisation of reperfusion therapy for STEMI in a developing country

Dharma, Surya and Andriantoro, Hananto and Dakota, Iwan and Purnawan, Ismi and Pratama, Vireza and Isnanijah, Herawati and Yamin, Muhammad and Bagus, Tjatur and Hartono, Benny and Ratnaningsih, Endang and Suling, Frits R.W and Basalamah, M Abas (2015) Organisation of reperfusion therapy for STEMI in a developing country. Open Heart, 2 (1). pp. 1-7.

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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 nonreperfused 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.

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