Two-year mortality of primary angioplasty for acute myocardial infarction during regular working hours versus off-hours

Dharma, Surya; Dakota, Iwan; Sukmawan, Renan; Andriantoro, Hananto; Siswanto, Bambang Budi; Rao, Sunil V.

doi:10.1016/j.carrev.2018.03.011

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…The results from the registry analysis will be translated into clinical practice by giving knowledge on how to improve patient care and outcomes. Since its inception in 2007, the JAC registry has contributed to the improvement of STEMI care in the region 12–14. Recently, the JAC registry has been expanded to 56 health centres and like other registries,4–7 this report is used as a performance measure for the STEMI care that included several insights to improve the STEMI care in the region which are described below.…”

Section: Discussionmentioning

confidence: 99%

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

Andriantoro

Purnawan³

et al. 2016

BMJ Open

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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 non-reperfused 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 non-reperfused 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 intra-aortic 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 door-out (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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Section: Discussionmentioning

confidence: 99%

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

Andriantoro

Purnawan³

et al. 2016

BMJ Open

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“…The JAC registry has been used widely as the main source of data for measuring the performance of the STEMI network in Jakarta, Indonesia. [11][12][13]…”

Section: Methodsmentioning

confidence: 99%

“…Offhours admission was defined as admission at the primary PCI center during weeknights (Monday through Thursday; 4 PM to 7.30 AM and Friday; 4.30 PM to 7.30 AM), weekends, and holidays. 13…”

Section: Definition Of Variablesmentioning

confidence: 99%

“Door-In to Door-Out” Delay in Patients with Acute ST-Segment Elevation Myocardial Infarction Transferred for Primary Percutaneous Coronary Intervention in a Metropolitan STEMI Network of a Developing Country

et al. 2019

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Routine performance measures of primary percutaneous coronary intervention (PCI) within an ST-segment elevation myocardial infarction (STEMI) network are needed to improve care.We evaluated the door-in to door-out (DI–DO) delays at the initial hospitals in STEMI patients as a routine performance measure of the metropolitan STEMI network.We retrospectively analyzed the DI–DO time from 1,076 patients with acute STEMI who were transferred by ground ambulance to a primary PCI center for primary PCI between 4 October 2014 and 1 April 2019. Correlation analysis between DI–DO times and total ischemia time was performed using Spearman's test. Logistic regression analyses were used to find variables associated with a longer DI–DO time.Median DI–DO time was 180 minutes (25th percentile to 75th percentile: 120–252 minutes). DI–DO time showed a positive correlation with total ischemia time (r = 0.4, p < 0.001). The median door-to-device time at the PCI center was 70 minutes (25th percentile to 75th percentile: 58–88 minutes). Multivariate analysis showed that women patients were independently associated with DI–DO time > 120 minutes (odds ratio 1.55, 95% confidence interval 1.03 to 2.33, p = 0.03).The DI–DO time reported in this study has not reached the guideline recommendation. To improve the overall performance of primary PCI in the region, interventions aimed at improving the DI–DO time at the initial hospitals and specific threat for women patients with STEMI are possibly the best efforts in improving the total ischemia time.

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“…The methodology of the registry, characteristics of the network, and several performance measures of the STEMI network have been undertaken and previously published. [9][10][11][12][13]…”

Section: Jakarta Acute Coronary Syndrome Registrymentioning

confidence: 99%

Interhospital Transfer versus Direct Admission in Patients with Acute ST-Segment Elevation Myocardial Infarction

et al. 2020

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There is concern whether patients with ST-segment elevation myocardial infarction (STEMI) who admitted to a percutaneous coronary intervention (PCI) center from interhospital transfer is associated with longer reperfusion time compared with direct admission. We evaluated the reperfusion delays in patients with STEMI who admitted to a primary PCI center through interhospital transfer or direct admission. We retrospectively analyzed 6,494 consecutive STEMI patients admitted between 2011 and 2019. Compared with direct admission (n = 4,121; 63%), interhospital transferred patients (n = 2,373) were younger (55 ± 10 vs. 56 ± 10 years, p < 0.001), had similar gender (85.6 vs. 86% male, p = 0.67), greater proportion of off-hour admission (65.2 vs. 48.3%, p < 0.001), less diabetes mellitus (28 vs. 30.8%, p = 0.019), and received more primary PCI (70.5 vs. 48.7%, p < 0.001). Interhospital transferred patients who received primary PCI (n = 3,677) or fibrinolytic (n = 238) had longer symptom-to-PCI center admission time (median, 360 vs. 300 minutes, p < 0.001), shorter door-to-device (DTD) time for primary PCI (median, 74 vs. 87 minutes, p < 0.001), and longer total ischemic time (median, 465 vs. 414 minutes, p < 0.001). Logistic regression in interhospital transferred patients showed that delay in door-in-to-door-out (DI-DO) time at the first hospital was strongly associated with prolonged total ischemic time (adjusted odds ratio = 3.92; 95% confidence interval: 3.06–5.04, p < 0.001). This study suggests that although interhospital transferred patients received more primary PCI with shorter DTD time, interhospital transfer creates longer total ischemic time that associates with the delay in DI-DO time at the first hospital that should be improved.

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Two-year mortality of primary angioplasty for acute myocardial infarction during regular working hours versus off-hours

Cited by 9 publications

References 13 publications

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

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

“Door-In to Door-Out” Delay in Patients with Acute ST-Segment Elevation Myocardial Infarction Transferred for Primary Percutaneous Coronary Intervention in a Metropolitan STEMI Network of a Developing Country

Interhospital Transfer versus Direct Admission in Patients with Acute ST-Segment Elevation Myocardial Infarction

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