Dharma Surya, Andriantoro Hananto, Dakota Iwan, Purnawan Ismi, Pratama Vireza, Isnanijah Herawati, Yamin Muhammad, Bagus Tjatur, Hartono Benny, Ratnaningsih Endang, Suling Frits, Basalamah M Abas
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia.
Chairman, Indonesian Heart Association, Jakarta Branch , Indonesia.
Open Heart. 2015 May 21;2(1):e000240. doi: 10.1136/openhrt-2015-000240. eCollection 2015.
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.
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.
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).
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.
NCT 02319473, Clinicaltrials.gov.
需要对ST段抬高型心肌梗死（STEMI）患者护理系统的性能指标进行常规评估，以改善STEMI网络。我们试图评估2010年引入STEMI网络的一个发展中国家首都城市中STEMI再灌注治疗的现状。
数据来自当地登记处。对一家国家心血管医院急诊科在三个不同时期（2007年、2010年和2013年）收治的28812例患者进行回顾性分析；其中有2703例STEMI患者。
与2007年相比，2013年直接经皮冠状动脉介入治疗（PCI）的数量大幅增加（35%对24%，p<0.001），未进行再灌注治疗的患者比例下降（62.8%对67.7%，p<0.001）。STEMI总体死亡率也有所改善（7.5%对11.7%，p<0.001）。
实施STEMI区域护理系统可能会提高直接PCI的利用率。在印度尼西亚这样的发展中国家，未来再灌注治疗的组织强烈需要一种侧重于院前护理的策略，以尽量减少从首次医疗接触到再灌注治疗的延迟，这可能会降低未进行再灌注治疗患者的比例。这些策略符合指南建议，可能会减少或消除发展中国家医疗保健方面的差距，特别是STEMI患者对循证治疗的利用不足。
NCT 02319473，Clinicaltrials.gov。
