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Organisation of reperfusion therapy for STEMI in a developing country.

Dharma S, Andriantoro H, Dakota I, Purnawan I, Pratama V, Isnanijah H, Yamin M, Bagus T, Hartono B, Ratnaningsih E, Suling F, Basalamah MA - Open Heart (2015)

Bottom Line: Data were obtained from a local registry.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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia.

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.

No MeSH data available.


Related in: MedlinePlus

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.
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OPENHRT2015000240F2: 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.

Mentions: In 2013 compared with 2007, the number of STEMI patients receiving primary PCI had increased significantly (35% vs 24%, p<0.001), while the use of in-hospital fibrinolytic therapy had decreased (2.2% vs 7.9%, p<0.001). The proportion of patients who did not receive acute reperfusion therapy had fallen significantly in 2013 compared with 2007 (62.8% vs 67.7%, p<0.001). The distribution of acute reperfusion therapy is shown in figure 2.


Organisation of reperfusion therapy for STEMI in a developing country.

Dharma S, Andriantoro H, Dakota I, Purnawan I, Pratama V, Isnanijah H, Yamin M, Bagus T, Hartono B, Ratnaningsih E, Suling F, Basalamah MA - Open Heart (2015)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4442233&req=5

OPENHRT2015000240F2: 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.
Mentions: In 2013 compared with 2007, the number of STEMI patients receiving primary PCI had increased significantly (35% vs 24%, p<0.001), while the use of in-hospital fibrinolytic therapy had decreased (2.2% vs 7.9%, p<0.001). The proportion of patients who did not receive acute reperfusion therapy had fallen significantly in 2013 compared with 2007 (62.8% vs 67.7%, p<0.001). The distribution of acute reperfusion therapy is shown in figure 2.

Bottom Line: Data were obtained from a local registry.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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia.

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.

No MeSH data available.


Related in: MedlinePlus