PMID- 27236389
OWN - NLM
STAT- MEDLINE
DCOM- 20170620
LR  - 20181113
IS  - 0975-4466 (Electronic)
IS  - 0256-4947 (Print)
IS  - 0256-4947 (Linking)
VI  - 36
IP  - 3
DP  - 2016 May-Jun
TI  - Trends in evidence-based treatment and mortality for ST elevation myocardial 
      infarction in Malaysia from 2006 to 2013: time for real change.
PG  - 184-9
LID - 10.5144/0256-4947.2016.184 [doi]
AB  - 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 19483 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 < .001). CONCLUSION: Adherence to 
      evidence-based treatment in STEMI in Malaysia is still poor especially in terms 
      of the rate of primary PCI. Although there is a general trend toward reduced 
      30-day mortality, the reduction was only slight over the study period. Drastic 
      effort is needed to improve adherence and clinical outcomes. LIMITATION: 
      Retrospective registry data with inter-hospital variation.
FAU - Venkatason, Padmaa
AU  - Venkatason P
FAU - Zubairi, Yong Z
AU  - Zubairi YZ
FAU - Hafidz, Imran
AU  - Hafidz I
FAU - Wan, Wan Azman
AU  - Wan WA
FAU - Zuhdi, Ahmad S
AU  - Zuhdi AS
AD  - Dr. Ahmad S. Zuhdi, Division of Cardiology,, University Malaya Medical Centre,, 
      Faculty of Medicine, Kuala Lumpur, Malaysia, T: 603-79494422, F: 603-79562253, 
      syadizuhdi@yahoo.co.uk, ORCID ID: orcid.org/0000-0002-5349-0301.
LA  - eng
PT  - Journal Article
PL  - Saudi Arabia
TA  - Ann Saudi Med
JT  - Annals of Saudi medicine
JID - 8507355
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - 0 (Purinergic P2Y Receptor Antagonists)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Angiotensin Receptor Antagonists/therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Cardiac Catheterization/*trends
MH  - Evidence-Based Medicine
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage
MH  - Guideline Adherence/*trends
MH  - Hospital Mortality/*trends
MH  - Humans
MH  - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
MH  - Malaysia/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Percutaneous Coronary Intervention/*trends
MH  - Practice Guidelines as Topic
MH  - Purinergic P2Y Receptor Antagonists/therapeutic use
MH  - Retrospective Studies
MH  - ST Elevation Myocardial Infarction/*mortality/*therapy
PMC - PMC6074549
EDAT- 2016/05/30 06:00
MHDA- 2017/06/21 06:00
PMCR- 2016/05/01
CRDT- 2016/05/30 06:00
PHST- 2016/05/30 06:00 [entrez]
PHST- 2016/05/30 06:00 [pubmed]
PHST- 2017/06/21 06:00 [medline]
PHST- 2016/05/01 00:00 [pmc-release]
AID - asm-3-184 [pii]
AID - 10.5144/0256-4947.2016.184 [doi]
PST - ppublish
SO  - Ann Saudi Med. 2016 May-Jun;36(3):184-9. doi: 10.5144/0256-4947.2016.184.