BMJ open · 2016
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.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Dharma Surya, Andriantoro Hananto, Purnawan Ismi, Dakota Iwan, Basalamah Faris, Hartono Beny, Rasmin Ronaly, Isnanijah Herawati, Yamin Muhammad, Wijaya Ika Prasetya, Pratama Vireza, Gunarto Tjatur Bagus, Juwana Yahya Berkahanto, Suling Frits R W, Witjaksono A M Onny, Lasanudin Hengkie F, Iskandarsyah Kurniawan, Priatna Hardja, Tedjasukmana Pradana, Wahyumandradi Uki, Kosasih Adrianus, Budhiarti Imelda A, Pribadi Wisnoe, Wirianta Jeffrey, Lubiantoro Utojo, Pramesti Rini, Widowati Diah Retno, Aminda Sissy Kartini, Basalamah M Abas, Rao Sunil V
Аннотация
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.
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.
Предметные рубрики MeSH
Acute Coronary SyndromeAgedDeveloping CountriesDrug-Eluting StentsEmergency Service, HospitalFemaleHospital MortalityHumansIndonesiaLogistic ModelsMaleMiddle AgedMultivariate AnalysisMyocardial ReperfusionPercutaneous Coronary InterventionRegistriesRetrospective StudiesST Elevation Myocardial InfarctionThrombolytic TherapyTime Factors