Organisation of reperfusion therapy for STEMI in a developing country

Surya Dharma, Hananto Andriantoro, Iwan Dakota, Ismi Purnawan, Vireza Pratama, Herawati Isnanijah, Muhammad Yamin, Tjatur Bagus, Benny Hartono, Endang Ratnaningsih, Frits Suling, M Abas Basalamah, Surya Dharma, Hananto Andriantoro, Iwan Dakota, Ismi Purnawan, Vireza Pratama, Herawati Isnanijah, Muhammad Yamin, Tjatur Bagus, Benny Hartono, Endang Ratnaningsih, Frits Suling, M Abas Basalamah

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.

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.

References

    1. Kolansky DM. Acute coronary syndromes: morbidity, mortality and pharmacoeconomic burden. Am J Manag Care 2009;15:S36–41.
    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
    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
    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
    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
    1. Widimsky P, Wijns W, Fajadet J et al. . Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 2010;31:943–57. 10.1093/eurheartj/ehp492
    1. Bradley SM, Carey EP, Ho PM. US Growth in PCI care—less than ideal, but is the ideal less? J Am Heart Assoc 2013;2:e000552 10.1161/JAHA.113.000552
    1. Dharma S, Juzar DA, Firdaus I et al. . Acute myocardial infarction system of care in the third world. Neth Heart J 2012;20:254–9. 10.1007/s12471-012-0259-9
    1. Dharma S, Siswanto BB, Firdaus I et al. . Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System. PLoS ONE 2014;9:e86665 10.1371/journal.pone.0086665
    1. Kristensen SD, Laut KG, Fajadet J et al. . Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011:current status in 37 ESC countries. Eur Heart J 2014;35:1957–70. 10.1093/eurheartj/eht529
    1. Claeys MJ, de Meester A, Convens C et al. . Contemporary mortality differences between primary percutaneous coronary intervention and thrombolysis in ST-segment elevation myocardial infarction. Arch Intern Med 2011;171:544–9. 10.1001/archinternmed.2011.57
    1. Dorler J, Alber HF, Altenberger J et al. , Austrian PCI investigators. Primary percutaneous coronary intervention of ST-elevation myocardial infarction in Austria: results from the Austrian acute PCI registry 2005–2007. Wien Klin Wochenschr 2010;122:220–8. 10.1007/s00508-010-1352-y
    1. Angeli F, Del Pinto M, Rasetti G et al. , Gruppo di Studio Registro Regionale dell'Umbria; Umbria STEMI. Management of ST-elevation myocardial infarction in the Umbria region: results from the observational prospective Umbria-STEMI registry. G Ital Cardiol (Rome) 2010;11:393–401.
    1. Diaz JF, de la Torre JM, Sabate M et al. . Spanish Cardiac Catheterization and Coronary Intervention Registry. 19th official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990–2009). Rev Esp Cardiol 2010;63:1304–16. 10.1016/S0300-8932(10)70300-6
    1. Sinnaeve PR, Armstrong PW, Gershlick AH et al. . ST-segment elevation myocardial infarction patients randomized to a pharmaco-invasive strategy or primary percutaneous coronary intervention: strategic reperfusion early after myocardial infarction (STREAM) 1-year mortality follow-up. Circulation 2014;130:1139–45. 10.1161/CIRCULATIONAHA.114.009570
    1. Tunstall Pedoe H, Vanuzzo D, Hobbs M et al. . Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project population. Lancet 2000;355:688–700. 10.1016/S0140-6736(99)11181-4
    1. Lambert LJ, Brown KA, Boothroyd LJ et al. . Transfer of patients with ST-elevation myocardial infarction for primary percutaneous coronary intervention. A province-wide evaluation of “door-in to door-out” delays at the first hospital. Circulation 2014;129:2653–60. 10.1161/CIRCULATIONAHA.113.007130
    1. Zeymer U, Arntz HR, Dirks B. Reperfusion rate and inhospital mortality of patients with ST segment elevation myocardial infarction diagnosed already in the prehospital phase: results of the German Prehospital Myocardial Infarction Registry (PREMIR). Resuscitation 2009;80:402–6. 10.1016/j.resuscitation.2008.12.004
    1. Danchin N, Coste P, Ferreres J et al. , for the FAST-MI Investigators. Comparison of thrombolysis followed by broad use of percutaneous coronary intervention with primary percutaneous coronary intervention for ST-segment-elevation acute myocardial infarction: data from the French registry on acute ST-elevation myocardial infarction (FAST-MI). Circulation 2008;118:268–76. 10.1161/CIRCULATIONAHA.107.762765
    1. Kalla K, Christ G, Karnik R et al. , for the Vienna STEMI Registry Group. Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry). Circulation 2006;113:2398–405. 10.1161/CIRCULATIONAHA.105.586198
    1. Sherwood MW. Developing regional STEMI systems of care: final results of the Mission: Lifeline STEMI ACCELERATOR study. Presented at: American Heart Association Scientific Sessions; 19 November 2014; Chicago, IL.
    1. Terkelsen CJ, Pinto DS, Thiele H et al. . 2012 ESC STEMI guidelines and reperfusion therapy: Evidence base ignored, threatening optimal patients management. Heart 2013;99:1154–6. 10.1136/heartjnl-2013-304117
    1. Sejersten M, Sillesen M, Hansen PR et al. . Effect on treatment delay of prehospital teletransmissionof 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation myocardial infarction to primary percutaneous coronary intervention. Am J Cardiol 2008;101:941–6. 10.1016/j.amjcard.2007.11.038
    1. Fox KA, Goodman SG, Anderson JA Jr et al. . From guidelines to clinical practice: the impact of hospital and geographical characteristics on temporal trends in the management of acute coronary syndromes. The Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2003;24:1414–24. 10.1016/S0195-668X(03)00315-4
    1. Laut KG, Gale CP, Pedersen AB et al. . Persistent geographical disparities in the use of primary percutaneous coronary intervention in 120 European regions: exploring the variation. EuroIntervention 2013;9:469–76. 10.4244/EIJV9I4A76
    1. Welsh RC, Travers A, Senaratne M et al. . Feasibility and applicability of paramedic-based prehospital fibrinolysis in a large North American Center. Am Heart J 2006;152:1007–14. 10.1016/j.ahj.2006.06.022
    1. Bjorklund E, Stenestrand U, Lindback J et al. . Pre-hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance transported real-life patients with ST-elevation myocardial infarction. Eur Heart J 2006;27:1146–52. 10.1093/eurheartj/ehi886

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться