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Original research article
Organisation of reperfusion therapy for STEMI in a developing country
  1. Surya Dharma1,
  2. Hananto Andriantoro1,
  3. Iwan Dakota1,
  4. Ismi Purnawan2,
  5. Vireza Pratama3,
  6. Herawati Isnanijah4,
  7. Muhammad Yamin5,
  8. Tjatur Bagus6,
  9. Benny Hartono7,
  10. Endang Ratnaningsih8,
  11. Frits Suling9 and
  12. M Abas Basalamah10
  1. 1Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
  2. 2Chairman, Indonesian Heart Association, Jakarta Branch, Indonesia
  3. 3Department of Cardiology, Gatot Soebroto Army Central Hospital, Central Jakarta, Indonesia
  4. 4Department of Cardiology and Vascular Medicine, Pasar Rebo General Hospital, East Jakarta, Indonesia
  5. 5Integrated Cardiovascular Services, Cardiology Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo General Hospital, Central Jakarta, Indonesia
  6. 6Department of Cardiology, Dr Mintohardjo Hospital, Indonesian Naval Hospital, Central Jakarta, Indonesia
  7. 7Binawaluya Cardiac Center, East Jakarta, Indonesia
  8. 8Department of Cardiology and Vascular Medicine, Tarakan General Hospital, Central Jakarta, Indonesia
  9. 9Department of Cardiology and Vascular Medicine, Christian University of Indonesia General Hospital, East Jakarta, Indonesia
  10. 10Department of Cardiology and Vascular Medicine, Persahabatan Hospital, East Jakarta, Indonesia
  1. Correspondence to Dr Surya Dharma; drsuryadharma{at}yahoo.com

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.

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