ABSTRACT

Coronary heart disease (CHD) is one of the leading causes of mortality in Indonesia aside from stroke. To reduce the mortality rate, a highly time-dependent, adequate therapy is needed for patients with electrocardiographic features of ST-Elevation Myocardial Infarction (STEMI). The gold standard for reperfusion therapy is thirty minutes for fibrinolytics and ninety minutes for primary PCI. For a community hospital, conducting the reperfusion therapy can be a challenge due to various factors, including human resources, standard operating procedures, and the infrastructure needed. However, to refer the patient to a tertiary hospital often requires time longer than ninety minutes. Therefore, community hospitals should be able to act as the front line of the healthcare system by facilitating fibrinolytic therapy to reduce the mortality rate of CHD in Indonesia. Development of fibrinolytics treatment in community hospitals can be done by creating an expert-reviewed SOP, providing competent human resources, and equipping the hospital with the necessary infrastructure for the service. These are all done in order to keep up with the "golden period" of STEMI patients with a thirty-minute door-to-needle timeframe and reduce the mortality rate caused by ACS in Indonesia.

Keywords: Community Hospital, CHD, STEMI, Fibrinolytics.

ABSTRAK

Penyakit jantung koroner (PJK) merupakan salah satu penyebab utama kematian di Indonesia selain stroke. Untuk mengurangi angka kematian, terapi yang sangat tergantung waktu dan memadai diperlukan untuk pasien dengan fitur elektrokardiografi ST-Elevation Myocardial Infarction (STEMI). Standar emas untuk terapi reperfusi adalah tiga puluh menit untuk fibrinolitik dan sembilan puluh menit untuk PCI primer. Untuk rumah sakit komunitas, melakukan terapi reperfusi dapat menjadi tantangan karena berbagai faktor, termasuk sumber daya manusia, prosedur operasi standar, dan infrastruktur yang dibutuhkan. Namun, untuk merujuk pasien ke rumah sakit tersier seringkali membutuhkan waktu lebih dari sembilan puluh menit. Oleh karena itu, rumah sakit komunitas harus mampu berperan sebagai garda terdepan dalam sistem pelayanan kesehatan dengan memfasilitasi terapi fibrinolitik untuk menurunkan angka kematian PJK di Indonesia. Pengembangan pengobatan fibrinolitik di rumah sakit komunitas dapat dilakukan dengan membuat SOP yang ditinjau oleh ahli, menyediakan sumber daya manusia yang kompeten, dan melengkapi rumah sakit dengan infrastruktur yang diperlukan untuk pelayanan. Ini semua dilakukan untuk mengimbangi “masa emas” pasien STEMI dengan timeframe door-to-needle tiga puluh menit dan menekan angka kematian akibat SKA di Indonesia.

Kata Kunci: RS Komunitas, PJK, STEMI, Fibrinolitik.

Chang, L. & Yeh, R., (2014). Evaluation and Management of

ST-elevation Myocardial Infarction and Shock.

European Cardiology Review, 9(2), pp.88-91.

PERKI, Perhimpunan Dokter Spesialis Kardiovaskuler Indonesia., (2015). Pedoman Penatalaksanaan SIndrom Koroner Akut. Jurnal Kardiologi Indonesia.

O’Gara, P.T. et al., (2013). 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary. Circulation, 127(4).

Mark DB, Hlatky MA, O'Connor CM, Pryor DB, Wall TC, Honan MB, Phillips HR 3rd, Califf RM. Administration of thrombolytic therapy in the community hospital: established principles and unresolved issues. J Am Coll Cardiol. 1988 Dec;12(6 Suppl A):32A-43A. doi: 10.1016/0735-1097(88)92639-3. PMID: 2973487.

Grinfeld L, Berrocal D, Belardi J, Spinetta A, Matas CR, Oberti P, Doval H, Bazzino O, Cagide A. Fibrinolytics vs primary angioplasty in acute myocardial infarction (FAP): a randomized trial in a community hospital in Argentina. Journal of the American College of Cardiology. 1996;2(27):222A.

Elliott R, Barnes R. STEMI System of Care Policy. Policy. 2012 Jun 26;5:10.

Solhpour A, Yusuf SW. Fibrinolytic therapy in patients with ST-elevation myocardial infarction. Expert Review of Cardiovascular Therapy. 2014 Feb 1;12(2):201-15.

Oldgren J, Wernroth L, Stenestrand U. Fibrinolytic therapy and bleeding complications: risk predictors from RIKS-HIA. Heart. 2010 Sep 1;96(18):1451-7.

Tracy RP, Bovill EG. Fibrinolytic parameters and hemostatic monitoring: identifying and predicting patients at risk for major hemorrhagic events. The American journal of cardiology. 1992 Jan 3;69(2):A52-9.

Moyer P, Ornato JP, Brady Jr WJ, Davis LL, Ghaemmaghami CA, Gibler WB, Mears G, Mosesso Jr VN, Zane RD. Development of systems of care for ST-elevation myocardial infarction patients: the emergency medical services and emergency department perspective. Circulation. 2007 Jul 10;116(2):e43-8.