Comparative Overview of ST-Elevation Myocardial Infarction (STEMI) Epidemiology, Demographics, Management and Outcomes in 5 Asia-Pacific Countries - A Meta-Analysis.

AIMS To gain insight into the differences in demographics of STEMI patients in Asia-Pacific, as well as inter-country variation in treatment and mortality outcomes. METHODS Systematic review of published studies and reports from known registries in Australia, Japan, Korea, Singapore and Malaysia that began data collection after the year 2000. Supplementary self-report survey questionnaire on public health data answered by representative cardiologists working in these countries. RESULTS 20 studies comprising of 158420 patients were included in the meta-analysis. The mean age was 61.6 years. CKD prevalence was higher in Japan, whilst dyslipidemia was low in Korea. Use of aspirin, P2Y12 inhibitors and statins were high throughout, but ACEi/ARB and B-blocker prescriptions were lower in Japan and Malaysia. Reperfusion strategies varied greatly, with high rates of primary PCI in Korea (91.6%), whilst Malaysia relies far more on fibrinolysis (72.6%) than primary PCI (9.6%). Likewise, mortality differed, with one-year mortality from STEMI was considerably greater in Malaysia (17.9%) and Singapore (11.2%) than in Korea (8.1%), Australia (7.8%) and Japan (6.2%). The countries were broadly similar in development and public health indices. Singapore has the highest gross national income and total healthcare expenditure per capita while Malaysia has the lowest. Primary PCI is available in all countries 24/7/365. CONCLUSION Despite broadly comparable public health systems, differences exist in patient profile, in-hospital treatment and mortality outcomes in these 5 countries. Our study reveals areas for improvements. The authors advocate further registry-based multi-country comparative studies focused on the Asia-Pacific region.