1. 10 Year Experience with the Malaysian ACS & PCI Registries:
Joint Meeting of Coronary Revascularisation (JCR), Busan December 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

2. 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.

3. The NCVD Registries (e.2006)

4. NCVD PCI Registry
Report

5. 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 Kuala Lumpur, Malaysia: National Cardiovascular Disease Database, 2015.

6. 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 ( )

7. N ACS admissions = 14,763

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

10. N ACS admissions = 14,763

11. Hypertension 65% Diabetes 46%
CV Risk factors
(N=16,866)
2011
(N=4,047)
2012
(N=4,589)
2013
(N=6,127)
(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%

12. Presence of cumulative risk factors (Percentage),
NCVD-ACS Registry,

13. 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

14. Age group of patients by ACS stratum
NCVD-ACS Registry,
NSTEMI

17. Type of treatment among STEMI patients by Age Group ,
NCVD-ACS Registry,

18. NCVD ACS In-Hospital Mortality and 30-day Follow up: 2006-2010 VS 2011-2013
Outcome at discharge
30-day FU
Year
Outcome N %
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
13633
92.4
13440
1130
7.6
1323
Outcome at discharge is similar but 30 day outcomes improved significantly

20. 30-day outcome is better at cardiologist centre
Outcome at discharge
30-day FU
Physician Centre
Cardiologist Centre
Year
Outcome N %
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
11238
92.4
2395
11064
2376
934
7.6
196
1108
215
30-day outcome is better at cardiologist centre

21. 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

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

23. The NCVD PCI Registry…

24. SDPs for the NCVD PCI Registry

25. Baseline Characteristics

26. Cardiovascular Risk Factors

27. Coronary stent implants!

28. Clinical outcomes

29. Primary PCI in STEMI – with vs without transfer

30. MySTEMI Network (Klang Valley)

31. ... Addressing the problems >3 billion at risk

32. A recent hit…. with global implications

33. Regional collaboration – 2016 and beyond

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

35. 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

36. Sarawak General Hospital