title: Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry.
abstract: We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants.
  
  
  
  Retrospective cohort study.
  
  
  
  Emergency department of 56 health centres.
  
  
  
  3015 patients with acute coronary syndrome, of which 1024 patients had STEMI.
  
  
  
  Characteristics of reperfusion therapy.
  
  
  
  The majority of patients with STEMI (81%; N=826) were admitted to six academic percutaneous coronary intervention (PCI) centres. PCI centres received patients predominantly (56%; N=514) from a transfer process. The proportion of patients receiving acute reperfusion therapy was higher than non-reperfused patients (54% vs 46%, p<0.001), and primary PCI was the most common method of reperfusion (86%). The mean door-to-device (DTD) time was 102±68 min. In-hospital mortality of non-reperfused patients was higher than patients receiving primary PCI or fibrinolytic therapy (9.1% vs 3.2% vs 3.8%, p<0.001). Compared with non-academic PCI centres, patients with STEMI admitted to academic PCI centres who underwent primary PCI had shorter mean DTD time (96±44 min vs 140±151 min, p<0.001), higher use of manual thrombectomy (60.2% vs13.8%, p<0.001) and drug-eluting stent implantation (87% vs 69%, p=0.001), but had similar use of radial approach and intra-aortic balloon pump (55.7% vs 67.2%, and 2.2% vs 3.4%, respectively). In patients transferred for primary PCI, TIMI risk score ≥4 on presentation was associated with a prolonged door-in to door-out (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02).
  
  
  
  In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI-DO time along with improvement of DTD time at PCI centres.
  
  
  
  NCT02319473.
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: Hananto
authors: H
authors: Andriantoro
authors: Chairman, Indonesian Heart Association, Jakarta Branch, Jakarta, Indonesia.
authors: Ismi
authors: I
authors: Purnawan
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: Mitra Keluarga Hospital, Bekasi, Indonesia.
authors: Faris
authors: F
authors: Basalamah
authors: Binawaluya Cardiac Center, East Jakarta, Indonesia.
authors: Beny
authors: B
authors: Hartono
authors: Budhi Asih General Hospital, East Jakarta, Indonesia.
authors: Ronaly
authors: R
authors: Rasmin
authors: Pasar Rebo General Hospital, East Jakarta, Indonesia.
authors: Herawati
authors: H
authors: Isnanijah
authors: Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo General Hospital, Central Jakarta, Indonesia.
authors: Muhammad
authors: M
authors: Yamin
authors: Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo General Hospital, Central Jakarta, Indonesia.
authors: Ika Prasetya
authors: IP
authors: Wijaya
authors: Department of Cardiology, Gatot Soebroto Army Central Hospital, Central Jakarta, Indonesia.
authors: Vireza
authors: V
authors: Pratama
authors: Department of Cardiology, Dr Mintohardjo Hospital, Indonesian Naval Hospital, Central Jakarta, Indonesia.
authors: Tjatur Bagus
authors: TB
authors: Gunarto
authors: Mitra Keluarga Depok General Hospital, Depok, Indonesia.
authors: Yahya Berkahanto
authors: YB
authors: Juwana
authors: Department of Cardiology, Christian University of Indonesia General Hospital, East Jakarta, Indonesia.
authors: Frits R W
authors: FR
authors: Suling
authors: Department of Cardiology, St Carolus General Hospital, Central Jakarta, Indonesia.
authors: A M Onny
authors: AM
authors: Witjaksono
authors: Central Pertamina General Hospital, South Jakarta, Indonesia.
authors: Hengkie F
authors: HF
authors: Lasanudin
authors: Central Pertamina General Hospital, South Jakarta, Indonesia.
authors: Kurniawan
authors: K
authors: Iskandarsyah
authors: Tangerang General Hospital, Tangerang, Indonesia.
authors: Hardja
authors: H
authors: Priatna
authors: Premier Jatinegara General Hospital, Central Jakarta, Indonesia.
authors: Pradana
authors: P
authors: Tedjasukmana
authors: Sahid Sahirman General Hospital, Central Jakarta, Indonesia.
authors: Uki
authors: U
authors: Wahyumandradi
authors: Sumber Waras General Hospital, West Jakarta, Indonesia.
authors: Adrianus
authors: A
authors: Kosasih
authors: SantoYusuf General Hospital, North Jakarta, Indonesia.
authors: Imelda A
authors: IA
authors: Budhiarti
authors: Esnawan Antariksa Indonesian Air Force Hospital, East Jakarta, Indonesia.
authors: Wisnoe
authors: W
authors: Pribadi
authors: RS Diagram, New Siloam Hospital, Depok, Indonesia.
authors: Jeffrey
authors: J
authors: Wirianta
authors: Mitra Keluarga Kelapa Gading, North Jakarta, Indonesia.
authors: Utojo
authors: U
authors: Lubiantoro
authors: Fatmawati General Hospital, South Jakarta, Indonesia.
authors: Rini
authors: R
authors: Pramesti
authors: Fatmawati General Hospital, South Jakarta, Indonesia.
authors: Diah Retno
authors: DR
authors: Widowati
authors: Koja General Hospital, North Jakarta, Indonesia.
authors: Sissy Kartini
authors: SK
authors: Aminda
authors: Persahabatan General Hospital, East Jakarta, Indonesia.
authors: M Abas
authors: MA
authors: Basalamah
authors: Section Chief, Department of Cardiology, Duke University Medical Center, Durham VA Medical Center, Durham, North Carolina, USA.
authors: Sunil V
authors: SV
authors: Rao
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D003906:Developing Countries; D054855:Drug-Eluting Stents; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015425:Myocardial Reperfusion; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors