A Clinical Profile of Acute Coronary Syndrome Patients in Kupang

a result from 1-year iSTEMI registry

  • Aditya Angela Adam, MD Prof. DR. W. Z. Johannes General Hospital Kupang
  • Leonora Johana Tiluata, MD, FIHA Prof. DR. W. Z. Johannes General Hospital Kupang
  • Lowry Yunita, MD, FIHA Prof. DR. W. Z. Johannes General Hospital Kupang
  • Magma Purnawan Putra, MD, FIHA Prof. DR. W. Z. Johannes General Hospital Kupang
  • Niva Wilujeng, MD, FIHA Prof. DR. W. Z. Johannes General Hospital Kupang
  • Leonita Vivian Homalessy, MD Prof. DR. W. Z. Johannes General Hospital Kupang
  • Daniel Christian Fernandez Hutabarat, MD Prof. DR. W. Z. Johannes General Hospital Kupang
Keywords: acute coronary syndrome, myocardial infarction, registry, Kupang

Abstract

Background: Cardiovascular diseases (CVDs) have been the leading cause of global deaths over the years. In Indonesia, coronary heart disease (CHD) is the most common CVDs, responsible for 29% of all deaths in 2017. East Nusa Tenggara is one of the provinces in Indonesia with the highest prevalence of CHD, which corresponded with growing cases of acute coronary syndromes (ACS). Therefore, we develop a registry to obtain patients' profiles as a basis for strategy development in ACS management.

Methods: A retrospectively observational study was conducted on all patients who presented with ACS between January 2019 and September 2020 at a general hospital in Kupang, East Nusa Tenggara.  Data collected include demography, patient awareness and transfer history, risk factors, physical findings, diagnosis, workup, treatment, and mortality.

Results: A total of 282 patients with ACS (STEMI, 41,2%; NSTEACS, 58,8%) were included in this study. Most patients were male with a mean age of 58,2 ± 12,2 years and normal BMI (32.6%). Nearly 50% of all ACS patients have one or more comorbidities, followed by relatively low adherence to therapy. Half of the patients were referred, but only 16,9% of patients arrived at the first medical facility less than 1 hour after onset. Patients with NTSEACS had more risk factors than patients with STEMI. The median LOS was five days (range, 1-17 days) with 2,8% in-hospital death. The presence of patient and system delay might contribute to the low number of STEMI patients who received reperfusion therapy.

Conclusions: This research serves as the primary data for the improvement of acute coronary syndrome management in Kupang and East Nusa Tenggara.

Downloads

Download data is not yet available.

References

1. Ralapanawa U, Kumarasiri PVR, Jayawickreme KP, Kumarihamy P, Wijeratne Y, Ekanayake M, et al. Epidemiology and risk factors of patients with types of acute coronary syndrome presenting to a tertiary care hospital in Sri Lanka. BMC Cardiovasc Disord. 2019 Dec;19(1):229.
2. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 Oct;396(10258):1204–22.
3. Kementrian Kesehatan Republik Indonesia. Riset kesehatan dasar. Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI; 2013.
4. Kolansky DM. Acute coronary syndromes: morbidity, mortality, and pharmacoeconomic burden. Am J Manag Care. 2009 Mar;15(2 Suppl): S36-41.
5. Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 5 Tahun 2017 tentang Rencana Aksi Nasional Penanggulangan Penyakit Tidak Menular Tahun 2015-2019. Kementerian Kesehatan Republik Indonesia; 2017.
6. Mullvain R, Saman DM, Rostvedt A, Landgren P. ECG-to-Decision Time Impact on 30-Day Mortality and Reperfusion Times for STEMI Care. Crit Pathw Cardiol. 2018 Mar;17(1):19–24.
7. Santos RC de O dos, Goulart AC, Kisukuri ALX, Brandão RM, Sitnik D, Staniak HL, et al. Time-To-Treatment of Acute Coronary Syndrome and First Contact in the ERICO Study. Arquivos Brasileiros de Cardiologia 107 (4):323-330.
8. Violán C, Bejarano-Rivera N, Foguet-Boreu Q, Roso Llorach A, Pons-Vigués M, Martin Mateo M, et al. The burden of cardiovascular morbidity in a European Mediterranean population with multimorbidity: a cross-sectional study. BMC Fam Pract. 2016 Nov 3;17(1):150.
9. Management of acute coronary syndromes in developing countries: ACute Coronary Events—a multinational Survey of current management Strategies. American Heart Journal. 2011 Nov;162(5):852-859.e22.
10. Medagama A, Bandara R, De Silva C, Galgomuwa MP. Management of acute coronary syndromes in a developing country; time for a paradigm shift? An observational study. BMC Cardiovasc Disord. 2015 Dec;15(1):133.
11. Lee CY, Liu KT, Lu HT, Mohd Ali R, Fong AYY, Wan Ahmad WA. Sex and gender differences in presentation, treatment, and outcomes in acute coronary syndrome, a 10-year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database—Acute Coronary Syndrome (NCVD-ACS) registry. Widmer RJ, editor. PLoS ONE. 2021 Feb 8;16(2):e0246474.
12. McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. The American Journal of Medicine. 2011;124(1):40–7.
13. Sutton-Tyrrell K, Lassila HC, Meilahn E, Bunker C, Matthews KA, Kuller LH. Carotid Atherosclerosis in premenopausal and postmenopausal women and its association with risk factors measured after menopause. Stroke. 1998;29(6):1116–21.
14. Burke LA, Rosenfeld AG, Daya MR, Vuckovic KM, Zegre-Hemsey JK, Felix Diaz M, et al. Impact of comorbidities by age on symptom presentation for suspected acute coronary syndromes in the emergency department. European Journal of Cardiovascular Nursing. 2017;16(6):511–21.
15. Baechli C, Koch D, Bernet S, Gut L, Wagner U, Mueller B, et al. Association of comorbidities with clinical outcomes in patients after acute myocardial infarction. IJC Heart & Vasculature. 2020 Aug;29:100558.
16. Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet. 2004;364(9438):937–52.
17. Ueshima H, Sekikawa A, Miura K, Turin TC, Takashima N, Kita Y, et al. Cardiovascular disease and risk factors in Asia: a selected review. Circulation. 2008;118(25):2702–9.
18. Picariello C, Lazzeri C, Attanà P, Chiostri M, Gensini GF, Valente S. The Impact of hypertension on patients with acute coronary syndromes. International Journal of Hypertension. 2011;2011:1–7.
19. Zhou M, Liu J, Hao Y, Liu J, Huo Y, Smith SC, et al. Prevalence and in-hospital outcomes of diabetes among patients with acute coronary syndrome in China: findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project. Cardiovasc Diabetol. 2018;17(1):147.
20. Cardiovascular Division & Health Services Research Centre. Reducing the burden of CVD in Indonesia. Newtown: The George Institute for Global Health; 2017.
21. Malini H, Copnell B, Moss C. Considerations in adopting a culturally relevant diabetes health education programme: An Indonesian example. Collegian. 2017;24(2):183–90.
22. Nappoe S, Kurniawan M. Evaluasi capaian pemerataan layanan kesehatan berkeadilan di era JKN di Provinsi East Nusa Tenggara. Yogyakarta: Pusat Kebijakan dan Manajemen Kesehatan, FKKMK, UGM; 2020.
23. Sunjaya AP, Sunjaya AF, Priyana A. Insights and challenges of Indonesia's acute coronary syndrome telecardiology network: three-year experience from a single center and in west Jakarta, Indonesia. IOP Conf Ser: Mater Sci Eng. 2019;508:012142.
24. Dharma S, Andriantoro H, Purnawan I, Dakota I, Basalamah F, Hartono B, et al. 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. BMJ Open. 2016;6(8):e012193.
25. Kim I, Kim MC, Park KH, Sim DS, Hong YJ, Kim JH, et al. Prognostic significance of non-chest pain symptoms in patients with non-ST-segment elevation myocardial infarction. Korean J Intern Med. 2018;33(6):1111–8.
26. Yiadom MYAB, Baugh CW, McWade CM, Liu X, Song KJ, Patterson BW, et al. Performance of Emergency Department Screening Criteria for an Early ECG to Identify ST‐Segment Elevation Myocardial Infarction. JAHA [Internet]. 2017 Mar 15 [cited 2021 Sep 11];6(3). Available from: https://www.ahajournals.org/doi/10.1161/JAHA.116.003528
27. Diercks DB, Kirk JD, Lindsell CJ, Pollack CV, Hoekstra JW, Gibler WB, et al. Door-to-ECG time in patients with chest pain presenting to the ED. The American Journal of Emergency Medicine. 2006;24(1):1–7.
28. Martha JW, Sihite TA, Listina D. The Difference in Accuracy Between Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score in Predicting In-Hospital Mortality of Acute ST-Elevation Myocardial Infarction Patients. Cardiol Res. 2021;12(3):177–85.
29. Wassie M, Lee M-S, Sun BC, Wu Y-L, Baecker AS, Redberg RF, et al. Single vs. serial measurements of cardiac troponin level in the evaluation of patients in the emergency department with suspected acute myocardial infarction. JAMA Netw Open. 2021;4(2):e2037930.
Published
2022-06-13
Views & Downloads
Abstract views: 928   
Full Text (PDF) downloads: 568   
How to Cite
Adam, A., Tiluata, L., Yunita, L., Putra, M., Wilujeng, N., Homalessy, L., & Hutabarat, D. (2022). A Clinical Profile of Acute Coronary Syndrome Patients in Kupang. Indonesian Journal of Cardiology, 42(4), 109-118. https://doi.org/10.30701/ijc.1194