title: Utilizing a registry for ST segment elevation myocardial infarction from a tertiary care hospital in Thailand: opportunities to improve the quality of care.
abstract: BACKGROUND
  Treatment of acute coronary syndrome requires a reliable measurement of quality for ensuring evidence-based care. Clinical registries have been used to support quality improvement activities in some countries, but there are few data concerning their implementation in developing countries. In 2008, a multidisciplinary Siriraj ST segment elevation myocardial infarction (STEMI) registry team was formed with the intention to improve the process of care. This report summarizes observational data collected within the first year to characterize the clinical profile, management and in-hospital outcomes of STEMI patients at the author's institute.
  
  
  METHODS
  The present study is a prospective, observational study. From June 2008 through June 2009, data from all consecutive patients presenting within 24 hours of STEMI at Siriraj Hospital were collected. The patient's data on demographics, procedures, medications and in-hospital outcomes were collected.
  
  
  RESULTS
  During the 1-year period, 112 patients with STEMI were enrolled. The mean age was 59.3 years old and 81.3% were males. There was a high prevalence of diabetes, hypertension, dyslipidemia and current smoking. Median time from symptom onset to presentation was 120 minutes. 98 patients (84.8% of the patients) received reperfusion therapy in the form of thrombolytic therapy (21.4%) or primary percutaneous coronary intervention (PCI, 63.40%). For thrombolytic therapy, the median door to needle time was 68 minutes. Rescue PCI was performed in 20.8% of the thrombolytic treated patients. For primary PCI, the median door to balloon time was 118 minutes. In-hospital coronary artery bypass graft surgery was performed in 6% of the patients. In-hospital mortality rate was 9.8%. Re-infarction and stroke were rare events.
  
  
  CONCLUSIONS
  Despite a high utilization rate of reperfusion therapy the time to reperfusion therapy exceeds the length of time recommended by current guidelines. The authors' findings provide important data for future benchmarking and represent a significant opportunity for quality improvement in STEMI-related care and outcomes.
authors.affiliation: Divison of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. junetan_md@hotmail.com
authors.forename: Wiwun
authors.initials: W
authors.lastname: Tungsubutra
authors.forename: Chunhakasem
authors.initials: C
authors.lastname: Chotnaiwattarakul
authors.forename: Adisak
authors.initials: A
authors.lastname: Maneesai
authors.forename: Saowanee
authors.initials: S
authors.lastname: Naowapanich
authors.forename: Pradit
authors.initials: P
authors.lastname: Panchavinnin
authors.forename: Damras
authors.initials: D
authors.lastname: Tresukosol
authors.forename: Rewat
authors.initials: R
authors.lastname: Phankingtongkhum
authors.forename: Nattawut
authors.initials: N
authors.lastname: Wongpraparut
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement; D012042:Registries; D013785:Thailand; D015912:Thrombolytic Therapy