Organisation of reperfusion therapy for STEMI in a developing country

Abstract

ObjectiveRoutine 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.MethodsData 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.ResultsIn 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).ConclusionsImplementation 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 numberNCT 02319473, Clinicaltrials.gov.

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

“…The network will be coordinated by the emergency medical service and it will encompass the public emergency system (prehospital units, primary healthcare-based emergency units, general hospitals and STEMI hospitals). A 12-lead ECG transmission scheme is mandatory in the protocol through several methods 14. The 24/7 STEMI hospitals at each zone will receive the ECG transmission.…”

Association between Adherence to Guideline-Recommended Preventive Medications and In-Hospital Mortality among Non-Reperfused ST-Elevation Myocardial Infarction Patients Admitted to a Tertiary Care Academic Center in a Developing Country

“…Data quality was maintained and verified regularly by the primary investigator of the registry (SD). The hospital provides a 24/7 cardiovascular service, including primary percutaneous coronary intervention (pPCI) and is hosting the regional STEMI network [17][18][19]. More details on the STEMI network characteristics in Jakarta was previously described [17].…”

“…Acute reperfusion therapy, preferably timely primary percutaneous coronary intervention (pPCI) conducted maximally within 120 minutes since the first medical contact or STEMI diagnosis, is the best management for ischemic STEMI patients transferred from non-capable pPCI hospitals to capable pPCI hospitals [9,11]. Despite continued attempts to implement this emergency care in patients with STEMI presenting at hospitals, up to more than 50% of these patients still did not receive acute reperfusion therapy [14,15], especially in developing countries such as India [15], Indonesia [15][16][17][18][19], Phillipines [15], and Vietnam [20]. Even in developed countries, around 20%-30% of patients with STEMI who were eligible for reperfusion still failed to receive this evidence-based intervention [21][22][23].…”

Tempos de acesso a serviços de saúde face ao infarto do miocárdio

“…The length of stay in the healthcare network was more strongly correlated with the time to arrive at the referral hospitals in cardiology for both sexes, strengthening the importance of a network that is shaped and structured to facilitate the access to specific points in the health system, (21) minimizing care delays.…”