Reperfusion for all: reimagining STEMI care in low and middle income countries

The development and use of reperfusion therapy in ST-elevation myocardial infarction (STEMI) has been one of the great achievements of modern medicine in the United States of America and Western Europe. In the 1960s, one-year mortality rates after STEMI approached 30% in these countries. However, their numbers are dramatically different today: under ideal circumstances, reperfusion therapy – in combination with cardiac care units and other evidence-based treatments – has now lowered one-year mortality rates after STEMI to well under 10% in clinical trials. The goal of the last two decades in these countries has been to translate these outcomes under “ideal circumstances” into “real-world” practice.

The article by Dharma et al1 in this issue of AsiaIntervention turns the spotlight on STEMI systems of care in this process, focusing on the importance of delivering 24/7 reperfusion therapy. Most importantly, this retrospective analysis using the Jakarta Acute Coronary Syndrome (JAC) registry shows what is possible when adequate facilities and staffing exist within a regional STEMI network.
Not only were outstanding outcomes achieved in STEMI patients at this large centre in Indonesia, with the one-year mortality rate of pproximately 10% seen in the United States of America and Western Europe, but also the similarity of acute and one-year results between STEMI patients admitted during regular hours versus off-duty hours demonstrates that high performance is achievable even in challenging situations. However, as rightly emphasised by the authors, this has been achieved in an island of excellence where the catheterisation laboratory staff and “on-duty” cardiologists stay within the hospital during “off-duty” hours.