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

<jats:sec> <jats:title>Objective</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Design</jats:title> <jats:p>Retrospective cohort study.</jats:p> </jats:sec> <jats:sec> <jats:title>Setting</jats:title> <jats:p>Emergency department of 56 health centres.</jats:p> </jats:sec> <jats:sec> <jats:title>Participants</jats:title> <jats:p>3015 patients with acute coronary syndrome, of which 1024 patients had STEMI.</jats:p> </jats:sec> <jats:sec> <jats:title>Main outcome measure</jats:title> <jats:p>Characteristics of reperfusion therapy.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Trial registration number</jats:title> <jats:p>NCT02319473.</jats:p> </jats:sec>