title: Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.
abstract: OBJECTIVE
  Guideline implementation programs are of paramount importance in optimizing acute ST-elevation myocardial infarction (STEMI) care. Assessment of performance indicators from a local STEMI network will provide knowledge of how to improve the system of care.
  
  
  RESULTS
  Between 2008-2011, 1505 STEMI patients were enrolled. We compared the performance indicators before (n = 869) and after implementation (n = 636) of a local STEMI network. In 2011 (after introduction of STEMI networking) compared to 2008-2010, there were more inter-hospital referrals for STEMI patients (61% vs 56%, p<0.001), more primary percutaneous coronary intervention (PCI) procedures (83% vs 73%, p = 0.005), and more patients reaching door-to-needle time ≤ 30 minutes (84.5% vs 80.2%, p<0.001). However, numbers of patients who presented very late (>12 hours after symptom onset) were similar (53% vs 51%, NS). Moreover, the numbers of patients with door-to-balloon time ≤ 90 minutes were similar (49.1% vs 51.3%, NS), and in-hospital mortality rates were similar (8.3% vs 6.9%, NS) in 2011 compared to 2008-2010.
  
  
  CONCLUSIONS
  After a local network implementation for patients with STEMI, there were significantly more inter-hospital referral cases, primary PCI procedures, and patients with a door-to-needle time ≤ 30 minutes, compared to the period before implementation of this network. However, numbers of patients who presented very late, the targeted door-to-balloon time and in-hospital mortality rate were similar in both periods. To improve STEMI networking based on recent guidelines, existing pre-hospital and in-hospital protocols should be improved and managed more carefully, and should be accommodated whenever possible.
authors: Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
authors: Surya
authors: S
authors: Dharma
authors: Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
authors: Bambang Budi
authors: BB
authors: Siswanto
authors: Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
authors: Isman
authors: I
authors: Firdaus
authors: Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
authors: Iwan
authors: I
authors: Dakota
authors: Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
authors: Hananto
authors: H
authors: Andriantoro
authors: Department of Cardiology, M.C. Haaglanden, The Hague, The Netherlands.
authors: Alexander J
authors: AJ
authors: Wardeh
authors: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
authors: Arnoud
authors: A
authors: van der Laarse
authors: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands ; Interuniversity Cardiology Institute the Netherlands, Utrecht, the Netherlands.
authors: J Wouter
authors: JW
authors: Jukema
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D003695:Delivery of Health Care; D003710:Demography; D004562:Electrocardiography; D006760:Hospitalization; D006801:Humans; D007214:Indonesia; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging*; D012042:Registries; D013997:Time Factors; D014463:Ultrasonography