Abstract
Background : Patient with ST-Elevation Myocardial Infarction (STEMI) requires urgent reperfusion either with fibrinolytic or primary Percutaneous Coronary Intervention (PCI). In Malang, a communication network of STEMI has been developed. It connects Saiful Anwar General Hospital with all of the Public Health Centers (PHC) in Malang Raya to shorten system delay since 2015. Objective : To elucidate Malang’s communication network’s role in decreasing Major Adverse Cardiac Event (MACE) in STEMI patients. Methods : This is a retrospective cohort study. Study sample was taken from medical record. Non-network: 96 patients and 88 network patients. Statistical tests using SPSS version 20.0 software. Results : Bivariate analysis showed network-group has a significantly lower MACE (p=0.001). Door-to-balloon time was also lower in network-group (p=0.026). Multivariate analysis without confounder showed that network-group had significantly shorter door-to-reperfusion time (p=0.032) and lower MACE (p=0.035) compared to non-network group. But multivariate analysis with confounder door-to-balloon and door-to-needle failed to explain lower MACE incidence. Network-group (p=0.005) and reperfusion with primary PCI (p=0.05) significantly decreased MACE incidence. Conclusion : Malang’s STEMI communication network and reperfusion with primary PCI reduced MACE in STEMI patients in Saiful Anwar General Hospital Malang.
Highlights
The World Health Organization (WHO) estimates that 17.5 million people worldwide died of heart disease in 2012, which is 31% of the total number of deaths and is the leading cause of death.[1]
This study is aimed to determine whether the ST-Elevation Myocardial Infarction (STEMI) communication network can reduce the incidence of Major Adverse Cardiac Event (MACE) in STEMI patients who are treated at Saiful Anwar General Hospital
Inclusion criteria in this study patient with age more than 18 years old and diagnosed with STEMI who came to emergency room Saiful Anwar General Hospital either referred by the Public Health Center (PHC) through the STEMI Communication Network system or self admission
Summary
The World Health Organization (WHO) estimates that 17.5 million people worldwide died of heart disease in 2012, which is 31% of the total number of deaths and is the leading cause of death.[1]. Patient with ST-Elevation Myocardial Infarction (STEMI) requires urgent reperfusion either with fibrinolytic or primary Percutaneous Coronary Intervention (PCI). In Malang, a communication network of STEMI has been developed It connects Saiful Anwar General Hospital with all of the Public Health Centers (PHC) in Malang Raya to shorten system delay since 2015. Methods : This is a retrospective cohort study. Results : Bivariate analysis showed network-group has a significantly lower MACE (p=0.001). Door-to-balloon time was lower in network-group (p=0.026). Multivariate analysis without confounder showed that network-group had significantly shorter door-to-reperfusion time (p=0.032) and lower MACE (p=0.035) compared to non-network group. Network-group (p=0.005) and reperfusion with primary PCI (p=0.05) significantly decreased MACE incidence.
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