title: Trends in evidence-based treatment and mortality for ST elevation myocardial infarction in Malaysia from 2006 to 2013: time for real change.
abstract: BACKGROUND
  The administration of evidence-based pharmacotherapy and timely primary percutaneous coronary intervention have been shown to improve outcome in ST elevation myocardial infarction (STEMI). However, implementation remains a challenge due to the limitations in facilities, expertise and funding.
  
  
  OBJECTIVE
  To investigate adherence to guideline-based management and mortality of STEMI patients in Malaysia.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  STEMI patients from 18 participating hospital across Malaysia included in the National Cardiovascular Database-Acute Coronary Syndrome (NCVD-ACS) registry year 2006 to 2013.
  
  
  METHODS
  Patients were categorized into four subgroups based on the year of admission (2006 to 2007, 2008 to 2009, 2010 to 2011 and 2012 to 2013). Baseline characteristics and clinical presentation, in-hospital pharmacotherapy, invasive revascularization and in-hospital/30-day mortality were analysed and compared between the subgroups.
  
  
  METHODS
  Rate of in-hospital catheterization/percutaneous coronary intervention.
  
  
  RESULTS
  The registry contained data on 19483 patients. Intravenous thrombolysis was the main reperfusion therapy. Although the overall rate of in-hospital catheterisation/PCI more than doubled over the study period, while the use of primary PCI only slowly increased from 7.6% in 2006/2007 to 13.6% in 2012/2013. The use of evidence-based oral therapies increased steadily over the years except for ACe-inhibitors and angiotensin-receptor blockers. The adjusted risk ratios (RR) for in-hospital mortality for the four sub-groups have not shown any significant improvement. The 30-day adjusted risk ratios however showed a significant albeit gradual risk reduction (RR 0.773 95% CI 0.679-0.881, P < .001).
  
  
  CONCLUSIONS
  Adherence to evidence-based treatment in STEMI in Malaysia is still poor especially in terms of the rate of primary PCI. Although there is a general trend toward reduced 30-day mortality, the reduction was only slight over the study period. Drastic effort is needed to improve adherence and clinical outcomes.
  
  
  CONCLUSIONS
  Retrospective registry data with inter-hospital variation.
authors.forename: Padmaa
authors.initials: P
authors.lastname: Venkatason
authors.forename: Yong Z
authors.initials: YZ
authors.lastname: Zubairi
authors.forename: Imran
authors.initials: I
authors.lastname: Hafidz
authors.forename: Wan Azman
authors.initials: WA
authors.lastname: Wan
authors.affiliation: Dr. Ahmad S. Zuhdi, Division of Cardiology,, University Malaya Medical Centre,, Faculty of Medicine, Kuala Lumpur, Malaysia, T: 603-79494422, F: 603-79562253, syadizuhdi@yahoo.co.uk, ORCID ID: orcid.org/0000-0002-5349-0301.
authors.forename: Ahmad S
authors.initials: AS
authors.lastname: Zuhdi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000639:trends*; D019317:Evidence-Based Medicine; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D019983:Guideline Adherence / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000639:trends*; D017410:Practice Guidelines as Topic; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality* / Q000628:therapy*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D058921:Purinergic P2Y Receptor Antagonists