Trends in evidence-based treatment and mortality for ST elevation myocardial infarction in Malaysia from 2006 to 2013: time for real change
| Autor: | Padmaa Venkatason, Yong Z. Zubairi, Imran Hafidz, Wan Azman Wan Ahmad, Ahmad S. Zuhdi |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: | |
| Zdroj: | Annals of Saudi Medicine, Vol 36, Iss 3, Pp 184-189 (2016) |
| Druh dokumentu: | article |
| ISSN: | 0256-4947 0975-4466 |
| DOI: | 10.5144/0256-4947.2016.184 |
| Popis: | BACKGROUND: The administration of evidence-based pharmacotherapy and timely primary percutaneous coronary intervention have been shown to improve outcome in ST elevation myocardial infarction (STEMI). However, implementation remains a challenge due to the limitations in facilities, expertise and funding. OBJECTIVES: To investigate adherence to guideline-based management and mortality of STEMI patients in Malaysia. DESIGN: Retrospective analysis. SETTINGS: STEMI patients from 18 participating hospital across Malaysia included in the National Cardiovascular Database-Acute coronary syndrome (NCVD-ACS) registry year 2006 to 2013. PATIENTS AND METHODS: Patients were categorized into four subgroups based on the year of admission (2006 to 2007, 2008 to 2009, 2010 to 2011 and 2012 to 2013). Baseline characteristics and clinical presentation, in-hospital pharmacotherapy, invasive revascularization and in-hospital/30-day mortality were analysed and compared between the subgroups. MAIN OUTCOME MEASURE(S): Rate of in-hospital catheterization/percutaneous coronary intervention. RESULTS: The registry contained data on 19 483 patients. Intravenous thrombolysis was the main reperfusion therapy. Although the overall rate of in-hospital catheterisation/PCI more than doubled over the study period, while the use of primary PCI only slowly increased from 7.6% in 2006/2007 to 13.6% in 2012/2013. The use of evidence-based oral therapies increased steadily over the years except for ACE-inhibitors and angiotensin-receptor blockers. The adjusted risk ratios (RR) for in-hospital mortality for the four sub-groups have not shown any significant improvement. The 30-day adjusted risk ratios however showed a significant albeit gradual risk reduction (RR 0.773 95% CI 0.679-0.881, P |
| Databáze: | Directory of Open Access Journals |
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