Management of Acute Coronary Syndrome Indonesia : Insight from One ACS Multicenter Registry

Management of Acute Coronary Syndrome Indonesia : Insight from One ACS Multicenter Registry

  • Dafsah Arifa Juzar Jurnal Kardiologi Indonesia
  • Akhtar Fajar Muzakkir
  • Yose Ramda Ilhami
  • Nahar Taufiq
  • Tri Astiawati
  • I Made Junior R A
  • Miftah Pramudyo
  • Andria Priyana Cengkareng General Hospital, Jakarta
  • Afdhalun Hakim BP Batam Hospital, Batam & Riau Islands
  • Setyasih Anjarwani Department of Cardiology & Vascular Medicine, Faculty of Medicine, University of Brawijaya/Dr. Saiful Anwar General Hospital, Malang, East Java
  • Jusup Endang Dr. M. Yunus, Bengkulu General Hospital, Bengkulu
  • Bambang Widyantoro
Keywords: ACS

Abstract

Background

Acute coronary syndrome (ACS) is a life-threatening disorder which contributes to high morbidity and mortality in the world. Registry of ACS offers a great guidance for improvement and research. We collated a multicentre registry to gain information about demographic, management, and outcomes of ACS in Indonesia.

Methods

IndONEsia Acute Coronary Syndrome Registry (One ACS Registry) was a prospective nationwide multicenter registry with 14 hospitals participating in submitting data of ACS  via standardized electronic case report form (eCRF). Between July 2018 and June 2019, 7634 patients with ACS were registered. This registry recorded baseline characteristics; onset, awareness, and transfer time; physical examination and additional test; diagnosis; in-hospital medications and intervention; complications; and in-hospital outcomes.

Results

Nearly half of patients (48.8%) were diagnosed with STE-ACS. Most prevalent risk factors were male gender, smoking, hypertension. Patients with NSTE-ACS tended to have more concomitant diseases including diabetes mellitus, dyslipidemia, prior AMI, HF, PCI, and CABG. Majority of ACS patients in our registry (89.4%) were funded by national health coverage. Antiplatelet, anticoagulant, antihypertensive, and statins were prescribed as 24-hours therapy and discharge therapy; however presription of potent P2Y12 inhibitor was low. More STE-ACS patients underwent reperfusion therapy than non-reperfusion (65.2% vs. 34.8%), and primary PCI was the most common method (45.7%). Only 21.8% STE-ACS patients underwent reperfusion strategy within 0-3 hours of onset. Invasive strategy performed in 17.6% of NSTE-ACS patients, and only 6.7% performed early (within <24 hours). Patients underwent early invasive strategy had a shorter median LoS than late invasive strategy (P<0.001). A shorter median LoS also found in intermediate and low risk patients.  Mortality rate in our ACS patients was 8.9%; STE-ACS patients showed higher mortality than NSTE-ACS (11.7 vs. 6.2%).

Conclusion

Our registry showed a comparable proportion between STE- and NSTE-ACS patients, with male gender predominant in middle age. Both STE- and NSTE-ACS sharing the same risk factors. We need an improvement in referral time, especially in patients with STE-ACS. Evidence from our registry showed that there are two issues that need to be addressed in order to improve ACS outcomes: optimal and adequate medical treatment and invasive strategy.

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References

Kolansky, D. M. (2009). Acute coronary syndromes: morbidity, mortality, and pharmacoeconomic burden. The American Journal of Managed Care, 15(2 Suppl), S36-41. http://www.ncbi.nlm.nih.gov/ Korea Acute Myocardial Infarction Registry-National Institutes of Health Registry pubmed/19355807.
Bueno, H. (2018). Epidemiology of acute coronary syndromes. In A. J. Camm, T. F. Lüscher, G. Maurer, & P. W. Serruys (Eds.), ESC CardioMed. Oxford University Press. https://doi.org/10.1093/med/9780198784906.001.0001.
Balitbang Kemenkes RI. (2013). Riset Kesehatan Dasar 2013. https://pusdatin.kemkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf. p. 83–99. Accessed 5 June 2022.
Viana, M., Laszczyńska, O., Araújo, C., Borges, A., Barros, V., Ribeiro, A. I., Dias, P., Maciel, M. J., Moreira, I., Lunet, N., & Azevedo, A. (2020). Patient and system delays in the treatment of acute coronary syndrome. Revista Portuguesa de Cardiologia (English Edition), 39(3), 123–131. https://doi.org/10.1016/j.repce.2019.07.007.
Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L. P., Crea, F., Goudevenos, J. A., Halvorsen, S., Hindricks, G., Kastrati, A., Lenzen, M. J., Prescott, E., Roffi, M., Valgimigli, M., Varenhorst, C., Vranckx, P., Widimský, P., … Gale, C. P. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 39(2), 119–177. https://doi.org/10.1093/eurheartj/ehx393.
Bäck, M., Leosdottir, M., Hagström, E., Norhammar, A., Hag, E., Jernberg, T., Wallentin, L., Lindahl, B., & Hambraeus, K. (2021). The SWEDEHEART secondary prevention and cardiac rehabilitation registry (SWEDEHEART CR registry). European Heart Journal - Quality of Care and Clinical Outcomes, 7(5), 431–437. https://doi.org/10.1093/ehjqcco/qcab039.
Sim, D. S., & Jeong, M. H. (2017). Differences in the Korea Acute Myocardial Infarction Registry Compared with Western Registries. Korean Circulation Journal, 47(6), 811. https://doi.org/10.4070/kcj.2017.0027.
ACCESS Investigators. (2011). Management of acute coronary syndromes in developing countries: ACute Coronary Events—a multinational Survey of current management Strategies. American Heart Journal, 162(5), 852-859.e22. https://doi.org/10.1016/j.ahj.2011.07.029.
Kim, J. H., Chae, S.-C., Oh, D. J., Kim, H.-S., Kim, Y. J., Ahn, Y., Cho, M. C., Kim, C. J., Yoon, J.-H., Park, H.-Y., & Jeong, M. H. (2016). Multicenter Cohort Study of Acute Myocardial Infarction in Korea – Interim Analysis of the Korea Acute Myocardial Infarction Registry-National Institutes of Health Registry. Circulation Journal, 80(6), 1427–1436. https://doi.org/10.1253/circj.CJ-16-0061.
Lee, S. H., Kim, J. H., Jeong, M. H., Park, H., Jeong, Y. A., Ahn, Y., Kim, J. H., Chae, S. C., Kim, Y. J., Hur, S. H., Seong, I. W., Hong, T. J., Choi, D., Cho, M. C., Kim, C. J., Seung, K. B., Chung, W. S., Jang, Y. S., Cho, J. G., … Park, S. J. (2015). Clinical Characteristics and Outcomes of Acute ST-Segment Elevation Myocardial Infarction in Younger Korean Adults. Korean Circulation Journal, 45(4), 275. https://doi.org/10.4070/kcj.2015.45.4.275.
Zhang, S., Ge, J., Yao, K., & Qian, J. (2011). Meta-Analysis of Early Versus Deferred Revascularization for Non–ST-Segment Elevation Acute Coronary Syndrome. The American Journal of Cardiology, 108(9), 1207–1213. https://doi.org/10.1016/j.amjcard.2011.06.035.
Lagerqvist, B., James, S. K., Stenestrand, U., Lindbäck, J., Nilsson, T., & Wallentin, L. (2007). Long-Term Outcomes with Drug-Eluting Stents versus Bare-Metal Stents in Sweden. New England Journal of Medicine, 356(10), 1009–1019. https://doi.org/10.1056/NEJMoa067722.
Canto, J. G. et al. (2012) ‘Atherosclerotic Risk Factors and Their Association With Hospital Mortality Among Patients With First Myocardial Infarction (from the National Registry of Myocardial Infarction)’, The American Journal of Cardiology, 110(9), pp. 1256–1261. doi: 10.1016/j.amjcard.2012.06.025.
Chung, S.-C., Gedeborg, R., Nicholas, O., James, S., Jeppsson, A., Wolfe, C., Heuschmann, P., Wallentin, L., Deanfield, J., Timmis, A., Jernberg, T., & Hemingway, H. (2014). Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK. The Lancet, 383(9925), 1305–1312. https://doi.org/10.1016/S0140-6736(13)62070-X.
Chakraborty, S., Bandyopadhyay, D., Amgai, B., Sidhu, J. S., Paudel, R., Koirala, S., Hajra, A., Ghosh, R. K., & Lavie, C. J. (2021). Does Insurance Effect the Outcome in Patients With Acute Coronary Syndrome?: An Insight from the Most Recent National Inpatient Sample. Current Problems in Cardiology, 46(1), 100411. https://doi.org/10.1016/j.cpcardiol.2019.02.003.
Calvin, J. E., Roe, M. T., Chen, A. Y., Mehta, R. H., Brogan, G. X., DeLong, E. R., Fintel, D. J., Gibler, W. B., Ohman, E. M., Smith, S. C., & Peterson, E. D. (2006). Insurance Coverage and Care of Patients with Non–ST-Segment Elevation Acute Coronary Syndromes. Annals of Internal Medicine, 145(10), 739. https://doi.org/10.7326/0003-4819-145-10-200611210-00006.
Lin, C.-C., Lee, P.-Y., Chen, K.-C., Liao, P.-C., Hsu, J.-C., & Li, A.-H. (2020). Clinical, Demographic, and Biochemical Characteristics of Patients with Acute ST-Segment Elevation Myocardial Infarction: An Analysis of Acute Coronary Syndrome Registry Data of a Single Medical Center from 2005 to 2016. Acta Cardiologica Sinica, 36(1), 1–7. https://doi.org/10.6515/ACS.202001_36(1).20190704D.
Abdelmoneim, H. M., Hasan-Ali, H., & Abdulkader, S. S. (2014). Demographics of Acute Coronary Syndrome (ACS) Egyptian patients admitted to Assiut University Hospital: Validation of TIMI and GRACE scores. The Egyptian Journal of Critical Care Medicine, 2(1), 3–11. https://doi.org/10.1016/j.ejccm.2014.07.001.
Ramirez, A. and Hu, P. P. (2015) ‘Low High-Density Lipoprotein and Risk of Myocardial Infarction’, Clinical Medicine Insights: Cardiology, 9, p. CMC.S26624. doi: 10.4137/CMC.S26624.
Collet, J.-P. et al. (2021) ‘2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation’, European Heart Journal, 42(14), pp. 1289–1367. doi: 10.1093/eurheartj/ehaa575.
Kite, T. A. et al. (2022) ‘Timing of invasive strategy in non-ST-elevation acute coronary syndrome: a meta-analysis of randomized controlled trials’, European Heart Journal. doi: 10.1093/eurheartj/ehac213.
Jentzer, J. C. et al. (2019) ‘Utility and Challenges of an Early Invasive Strategy in Patients Resuscitated From Out-of-Hospital Cardiac Arrest’, JACC: Cardiovascular Interventions, 12(8), pp. 697–708. doi: 10.1016/j.jcin.2019.01.245.
Ten Have, P., Hilt, A. D., Paalvast, H., Eindhoven, D. C., Schalij, M. J., & Beeres, S. L. M. A. (2020). Non-ST-elevation myocardial infarction in the Netherlands: room for improvement! Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 28(10), 537–545. https://doi.org/10.1007/s12471-020-01433-x.
Hall, M., Bebb, O. J., Dondo, T. B., Yan, A. T., Goodman, S. G., Bueno, H., Chew, D. P., Brieger, D., Batin, P. D., Farkouh, M. E., Hemingway, H., Timmis, A., Fox, K. A. A., & Gale, C. P. (2018). Guideline-indicated treatments and diagnostics, GRACE risk score, and survival for non-ST elevation myocardial infarction. European Heart Journal, 39(42), 3798–3806. https://doi.org/10.1093/eurheartj/ehy517.
Lindholm, D. et al. (2014) ‘Ticagrelor vs. clopidogrel in patients with non-ST-elevation acute coronary syndrome with or without revascularization: results from the PLATO trial’, European Heart Journal, 35(31), pp. 2083–2093. doi: 10.1093/eurheartj/ehu160.
Valgimigli, M. et al. (2018) ‘2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS’, European Journal of Cardio-Thoracic Surgery, 53(1), pp. 34–78. doi: 10.1093/ejcts/ezx334.
PERKI (2018) Pedoman tata laksana sindroma koronerakut. 4th edn. Edited by D. A. Juzar et al. Jakarta.
Sibbing, D., Orban, M. and Massberg, S. (2013) ‘Potent P2Y12 receptor inhibitors in patients with acute coronary syndrome’, Hämostaseologie, 33(01), pp. 9–15. doi: 10.5482/HAMO-12-12-0022.
Yu, S., Jin, J., Chen, Z., & Luo, X. (2020). High-intensity statin therapy yields better outcomes in acute coronary syndrome patients: a meta-analysis involving 26,497 patients. Lipids in Health and Disease, 19(1), 194. https://doi.org/10.1186/s12944-020-01369-6.
Baigent, C. et al. (2010) ‘Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials’, The Lancet, 376(9753), pp. 1670–1681. doi: 10.1016/S0140-6736(10)61350-5.
Newby, L. K., Eisenstein, E. L., Califf, R. M., Thompson, T. D., Nelson, C. L., Peterson, E. D., Armstrong, P. W., van de Werf, F., White, H. D., Topol, E. J., & Mark, D. B. (2000). Cost Effectiveness of Early Discharge after Uncomplicated Acute Myocardial Infarction. New England Journal of Medicine, 342(11), 749–755. https://doi.org/10.1056/NEJM200003163421101.
Anderson, J. L., Adams, C. D., Antman, E. M., Bridges, C. R., Califf, R. M., Casey, D. E., Chavey, W. E., Fesmire, F. M., Hochman, J. S., Levin, T. N., Lincoff, A. M., Peterson, E. D., Theroux, P., Wenger, N. K., Wright, R. S., Smith, S. C., Jacobs, A. K., Adams, C. D., Anderson, J. L., … Riegel, B. (2007). ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Journal of the American College of Cardiology, 50(7), e1–e157. https://doi.org/10.1016/j.jacc.2007.02.013.
Vavalle, J. P., Lopes, R. D., Chen, A. Y., Newby, L. K., Wang, T. Y., Shah, B. R., Ho, P. M., Wiviott, S. D., Peterson, E. D., Roe, M. T., & Granger, C. B. (2012). Hospital Length of Stay in Patients with Non-ST-segment Elevation Myocardial Infarction. The American Journal of Medicine, 125(11), 1085–1094. https://doi.org/10.1016/j.amjmed.2012.04.038.
Karabulut, A., Cakmak, M., Uzunlar, B., & Bilici, A. (2011). What is the optimal length of stay in hospital for ST elevation myocardial infarction treated with primary percutaneous coronary intervention? Cardiology Journal, 18(4), 378–384. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21769818.
Swaminathan, R. v., Rao, S. v., McCoy, L. A., Kim, L. K., Minutello, R. M., Wong, S. C., Yang, D. C., Saha-Chaudhuri, P., Singh, H. S., Bergman, G., & Feldman, D. N. (2015). Hospital Length of Stay and Clinical Outcomes in Older STEMI Patients After Primary PCI. Journal of the American College of Cardiology, 65(12), 1161–1171. https://doi.org/10.1016/j.jacc.2015.01.028.
Published
2022-06-30
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How to Cite
Juzar, D., Muzakkir, A., Ilhami, Y., Taufiq, N., Astiawati, T., R A, I. M., Pramudyo, M., Priyana, A., Hakim, A., Anjarwani, S., Endang, J., & Widyantoro, B. (2022). Management of Acute Coronary Syndrome Indonesia : Insight from One ACS Multicenter Registry. Indonesian Journal of Cardiology, 43(2), 45-55. https://doi.org/10.30701/ijc.1406