Hospital outcomes in STEMI patients after the introduction of a regional STEMI network in the metropolitan area of a developing country

Surya Dharma; Hananto Andriantoro; Iwan Dakota; Renan Sukmawan; Isman Firdaus; Siska Suridanda Danny; Dian Zamroni; Bambang Budi Siswanto; Sunil V Rao

doi:10.4244/AIJ-D-17-00048

Hospital outcomes in STEMI patients after the introduction of a regional STEMI network in the metropolitan area of a developing country

AsiaIntervention. 2018 Sep 20;4(2):92-97. doi: 10.4244/AIJ-D-17-00048. eCollection 2018 Sep.

Authors

Surya Dharma¹, Hananto Andriantoro², Iwan Dakota², Renan Sukmawan, Isman Firdaus², Siska Suridanda Danny², Dian Zamroni², Bambang Budi Siswanto², Sunil V Rao³

Affiliations

¹ Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
² Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
³ The Duke Clinical Research Institute, Durham, NC, USA.

Abstract

Aims: Data on the long-term outcomes of STEMI patients treated via a network in Asian countries are very limited. We aimed to evaluate the characteristics and outcomes of STEMI patients at two different periods, before and five years after the establishment of a regional STEMI network in Jakarta, Indonesia.

Methods and results: Out of 6,291 patients with STEMI admitted to hospital between January 2008 to January 2016, we compared the characteristics and outcomes of STEMI patients from two different periods, January 2008 to July 2009 (before instalment of the STEMI network, N=624), and from January 2015 to January 2016 (five years after the start of the network, N=1,052). The PCI hospital is an academic tertiary care cardiac hospital and initiated the regional STEMI network in 2010. Logistic regression was used to determine the adjusted association between treatment in the latter period and mortality. Compared with data from 2008/2009, in the 2015/2016 period, more primary PCI procedures were performed (N=589 [56%] vs. N=176 [28%], p<0.001), fewer patients did not receive reperfusion therapy (37% vs. 59%, p<0.001), and median door-to-device (DTD) times were shorter (82 vs. 94 minutes, p<0.001). Overall in-hospital mortality decreased from 9.6% to 7.1% (adjusted odds ratio 0.72, 95% CI: 0.50 to 1.03, p=0.07).

Conclusions: Half a decade after the implementation of the STEMI network in Jakarta, Indonesia, the result is better and faster care for patients with STEMI and this has been associated with lower in-hospital mortality.