10 Year Experience with the Malaysian ACS & PCI Registries: Joint Meeting of Coronary Revascularisation (JCR), Busan. 9-10 December 2016. Session 5: 1550hrs, Room A 10 Year Experience with the Malaysian ACS & PCI Registries: translation into research and practice Dr Alan Fong MBChB(Bristol), MRCP(UK), FRCP (Edin), FACC, FESC, FAPSIC, FNHAM, FAsCC Consultant Cardiologist, Sarawak General Hospital Heart Centre; & Head, Clinical Research Centre, Sarawak General Hospital Adjunct Professor, Swinburne University of Technology

National Health and Morbidity Surveys.. (e.1986) NHMS 2015: of adults over 18, 17.5% have DM; 30.3% have hypertension; 47.7% have hypercholesterolaemia; 17.7% are obese, 22.8% smokers.

The NCVD Registries (e.2006) http://www.acrm.org.my/ncvd/aboutUs_overview.php

NCVD PCI Registry Report 2013-2014

Snapshot from the Annual Report of the NCVD-ACS Registry 2011-2013 Suggested citation: W.A. Wan Azman, K.H. Sim. (Eds). Annual Report of the NCVD-ACS Registry, Year 2011-2013. Kuala Lumpur, Malaysia: National Cardiovascular Disease Database, 2015.

NCVD-ACS Registry Participating Hospitals HTF HQEI HQEII HRPZ II HSB HPP HSNZ HRPB HTAA PJHUS UMMC IJN HKL HTAR HS HA Total SDP= 19 hospitals HTJ HSA *Each SDP started to contribute data at different time period HM NCVD-ACS Registry, Malaysia (2011-2013)

N ACS admissions = 14,763

Mean age: 58.5 (12.2) years N ACS admissions = 14,763

N ACS admissions = 14,763

Hypertension 65% Diabetes 46% CV Risk factors 2006-2010 (N=16,866) 2011 (N=4,047) 2012 (N=4,589) 2013 (N=6,127) 2011-2013 (N=14,763) Dyslipidaemia 33.0 39.2 36.4 37.0 37.4 Hypertension 61.0 67.0 65.6 63.2 65.0 Diabetes 43.0 46.2 46.6 45.0 45.8 Family History of premature CVD 11.0 14.5 13.2 12.4 MI history 19.0 22.0 20.8 16.2 19.2 Documented CAD 17.0 17.3 20.2 24.4 21.2 New onset angina (< 2 weeks) 55.0 61.4 57.6 56.4 58.2 Chronic angina (onset > 2 weeks ago) 11.4 9.6 9.4 9.9 Chronic Lung Disease 4.0 3.6 2.8 3.1 3.2 Renal disease 7.0 8.2 7.2 7.8 Peripheral vascular disease 1.0 1.2 0.8 0.6 Cerebrovascular disease 4.2 3.5 3.8 Heart Failure 8.6 5.3 Current Smoker 37.6 37.8 38.2 38.0 BMI > 23kgm-2 75.0 75.6 78.2 76.5 Hypertension 65% Diabetes 46%

Presence of cumulative risk factors (Percentage), NCVD-ACS Registry, 2011-2013

Type of cardiac presentation for patients with ACS (%) by admission, NCVD-ACS Registry, 2006 - 2013 2007 2008 2009 2010 2011 2012 2013 N 3,392 3,640 2,839 3,594 3,401 4,047 4,589 6,127 STEMI 42.0 46.0 54.0 47.0 53.0 50.8 52.0 50.0 NSTEMI 34.0 29.0 24.0 30.0 27.0 25.0 26.2 UA 22.0 17.0 22.2 23.3 23.8

Age group of patients by ACS stratum NCVD-ACS Registry, 2011-2013 NSTEMI

Type of treatment among STEMI patients by Age Group , NCVD-ACS Registry, 2011-2013

NCVD ACS In-Hospital Mortality and 30-day Follow up: 2006-2010 VS 2011-2013 Outcome at discharge 30-day FU Year Outcome N % 2006-2010 Alive 15531 92 14429 86 Died 1335 8 2437 14 2011 3729 92.2 3681 91.0 318 7.8 366 9.0 2012 4234 4173 355 416 2013 5670 92.6 5586 91.2 457 7.4 541 8.8 2011-2013 13633 92.4 13440 1130 7.6 1323 Outcome at discharge is similar but 30 day outcomes improved significantly

30-day outcome is better at cardiologist centre Outcome at discharge 30-day FU Physician Centre Cardiologist Centre Year Outcome N % 2006-2010 Alive 5163 92 10368 4905 87 9524 85 Died 454 8 881 712 13 1725 15 2011 2839 92.2 890 92.0 2801 91.0 880 241 7.8 77 8.0 279 9.0 2012 3368 866 92.6 3315 90.8 858 91.8 286 69 7.4 339 9.2 8.2 2013 5031 639 92.8 4948 638 407 50 7.2 490 51 2011-2013 11238 92.4 2395 11064 2376 934 7.6 196 1108 215 30-day outcome is better at cardiologist centre

STEMI: comparison between NCVD and TIMI developmental dataset An Asian Validation of the TIMI risk score for ST-Segment Elevation Myocardial Infarction: Results and Implications for Cardiac Care in a Developing Country. Sharmini Selvarajah, Alan Fong Yean Yip, Gunavathy Selvaraj, Jamaiyah Haniff, Cuno S.P.M. Uiterwaal, Michiel L. Bots, PLoS One 2012;7(7):e40249

STEMI reperfusion strategies in UK and Malaysia approx. 70% lytic, approx 9% PPCI NCVD 2013 – approx. 70% lytic, 9% with PPCI for STEMI

The NCVD PCI Registry…

SDPs for the NCVD PCI Registry

Baseline Characteristics

Cardiovascular Risk Factors

Coronary stent implants!

Clinical outcomes

Primary PCI in STEMI – with vs without transfer

MySTEMI Network (Klang Valley)

... Addressing the problems >3 billion at risk

A recent hit…. with global implications

Regional collaboration – 2016 and beyond

ACS – a patient from Marudi (~130km from Miri by road) Melaka to Serdang (2 hours)

Summary: how the NCVD has helped us…. Systematic collection of local data important Better understanding of the local disease burden Strategies to improve therapeutic protocols Addressing the evidence gap by research Translating research into guidelines

Sarawak General Hospital