Pengaruh Penerapan Program “CODE STEMI” terhadap Door to Balloon Time dan Major Adverse Cardiac Events Pasien ST Elevation Myocardial Infarction

Prijander Lombardia Funay, Ika Prasetya Wijaya, Eka Ginanjar, Hamzah Shatri

Abstract

Pendahuluan. Keterlambatan penanganan pasien ST elevation myocardial infarction (STEMI) menjadi penyebab tingginya mortalitas dan kejadian MACE (major adverse cardiac events). Upaya yang dapat dilakukan di fasilitas kesehatan dengan kemampuan primary percutaneous coronary intervention (PCI) adalah mencapai reperfusi tepat waktu pasien STEMI, di antaranya dengan menerapkan program CODE STEMI. Penelitian ini dilakukan untuk mengetahui pengaruh CODE STEMI terhadap door to balloon time (D2BT) dan MACE pasien STEMI yang menjalani primary PCI.

Metode. Penelitian ini merupakan studi kohort retrospektif pada pasien STEMI yang menjalani primary PCI, sebelum penerapan program CODE STEMI (2015-2016) dan sesudah penerapan program CODE STEMI (2017-2018). Data diperoleh dari rekam medis pasien yang kemudian dianalisis secara kuantitatif dengan uji Mann whitney untuk variabel D2BT dan chi square untuk variabel MACE.

Hasil. Terdapat 111 pasien pada kelompok non-CODE STEMI dan 144 pasien pada kelompok CODE STEMI. Door to balloon time berkurang bermakna dari 275 (rentang 99-2.356) menit pada kelompok non-CODE STEMI menjadi 165 (rentang 67-1.165) menit pada kelompok CODE STEMI (p < 0,001). Hasil analisis masing-masing variabel pada kelompok non-CODE STEMI dan CODE STEMI secara berturut-turut yaitu: kejadian MACE (48,4% vs. 51,6%; p = 0,120), gagal jantung (46,6% vs. 42%; p = 0,288), syok kardiogenik (27% vs. 19,4%; p = 0,152), aritmia (12,6% vs. 6,2%; p = 0,079), stroke (4,5% vs. 5,6%; p = 0,705), dan angka mortalitas (7,2% vs. 3,5%; p = 0,179). Didapatkan penurunan  infark berulang (4,5% vs. 0,7%; p = 0,047) dan PCI ulang (2,7% vs. 0,0%; p = 0,047) pada kelompok CODE STEMI dibandingkan kelompok non-CODE STEMI.

Kesimpulan. Program CODE STEMI memperbaiki D2BT. Program CODE STEMI tidak menurunkan kejadian MACE secara keseluruhan, namun menurunkan kejadian infark berulang dan PCI ulang pasien STEMI yang menjalani primary PCI.

Kata kunci: CODE STEMI, D2BT, MACE, primary PCI

 

The Impact of “CODE STEMI” Program Implementation on Door to Balloon Time and  Major Adverse Cardiac Events of Patients with ST Elevation Myocardial Infarction

Introduction. Delay in the management of ST Elevation Myocardial Infarction (STEMI) patients is a cause of high mortality and the incidence of major adverse cardiac events (MACE). Efforts that can be made in health facilities with primary percutaneous coronary intervention (PCI) capability are achieving timely reperfusion of STEMI patients. Various strategies were carried out to achieve timely reperfusion including implementation the CODE STEMI program. This study aimed to determine the effect of the implementation of the CODE STEMI program on Door to Balloon Time (D2BT) and MACE of STEMI patients undergoing primary PCI.

Methods. This was a retrospective cohort study conducted among STEMI patients undergoing primary PCI before the application of the CODE STEMI program (2015-2016) and after the application of the CODE STEMI program (2017-2018). Data were obtained from patients’ medical record. Analysis was performed quantitatively by Mann Whitney test for D2BT and chi square for MACE.

Results. There were 111 patients in the non-CODE STEMI group and 144 patients in the CODE STEMI group. D2BT decreased significantly 110 minutes from 275 (99-2356) minutes in the non-CODE STEMI group to 165 (67-1165) minutes in the CODE STEMI group (p < 0.001). Analysis in both group (CODE STEMI vs. non-CODE STEMI) showed as follows: MACE events (48.4% vs 51.6%; p = 0.120), heart failure (46.6% vs 42%; p = 0.288), cardiogenic shock (27% vs 19.4%; p = 0.152), arrhythmia (12.6% vs 6.2%; p = 0.079), stroke (4.5% vs 5.6%; p = 0.705), and mortality rate (7.2% vs 3.5%; p = 0.179) which were similar between the two groups. The incidence of reinfarction (4.5% vs 0.7%; p = 0.047) and repeated PCI (2.7% vs 0.0%; p = 0.047) were significantly reduced in the CODE STEMI group.

Conclusions. The CODE STEMI program reduces D2BT. The CODE STEMI program did not reduce the overall MACE incidence but reduced the incidence of reinfarction and repeated PCI of STEMI patients undergoing primary PCI.

Keywords

CODE STEMI, D2BT, MACE, primary PCI

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