Ginanjar Eka, Sjaaf Amal C, Alwi Idrus, Sulistyadi Wahyu, Suryadarmawan Ede, Wibowo Adik, Liastuti Lies Dina
Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia.
Open Access Emerg Med. 2020 Nov 2;12:315-321. doi: 10.2147/OAEM.S259155. eCollection 2020.
One of the most frequent causes of cardiac mortality is ST elevation myocardial infarction (STEMI). Delay in the management of STEMI patients is a cause of high mortality and morbidity. This study aims to determine the effect of the implementation of the CODE STEMI program on major adverse cardiac events (MACE) and mortality of STEMI patients at Dr. Cipto Mangunkusumo General Hospital.
This was a retrospective cohort study that enrolled 207 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) in 2015-2018. The patients were divided into two groups. The first group was treated prior to establishing the CODE STEMI program. The other group was treated according to the program, which was implemented in January 2017. Data were collected from medical records, and we retrospectively analyzed all in-hours, MACE, and mortality of STEMI patients from both groups as primary outcomes. Data analysis was done using the Mann-Whitney and chi-square test.
There were 72 and 135 patients in the pre-CODE STEMI and CODE STEMI groups, respectively. D2BT was significantly reduced by 130 min (288±306 vs 158±81, P< 0.001) since the implementation of CODE STEMI program. There were trends to lower in-hospital mortality rates (8.3% vs 4.4%, RR = 0.53) and MACE at 30 days (48.61% vs 37.78%, RR = 0.77).
Implementation of the CODE STEMI program can reduce door-to-balloon time and decrease the MACE and mortality rate in STEMI patients in general hospitals.
心脏性死亡最常见的原因之一是ST段抬高型心肌梗死（STEMI）。STEMI患者治疗的延迟是导致高死亡率和高发病率的一个原因。本研究旨在确定实施CODE STEMI项目对芝普托·曼贡库苏莫综合医院STEMI患者主要不良心脏事件（MACE）和死亡率的影响。
这是一项回顾性队列研究，纳入了2015年至2018年接受直接经皮冠状动脉介入治疗（PPCI）的207例STEMI患者。患者分为两组。第一组在CODE STEMI项目建立之前接受治疗。另一组按照该项目进行治疗，该项目于2017年1月实施。数据从医疗记录中收集，我们回顾性分析了两组STEMI患者的所有住院时间、MACE和死亡率作为主要结局。数据分析采用曼-惠特尼检验和卡方检验。
CODE STEMI项目实施前和实施后的两组患者分别有72例和135例。自CODE STEMI项目实施以来，门球时间显著缩短了130分钟（288±306分钟对158±81分钟，P<0.001）。住院死亡率有降低趋势（8.3%对4.4%，RR = 0.53），30天时MACE也有降低趋势（48.61%对37.78%，RR = 0.77）。
实施CODE STEMI项目可缩短门球时间，并降低综合医院STEMI患者的MACE和死亡率。
