Ryan Del Rosario Buendia
St. Luke’s Medical Center, Philippines
Ryan Buendia has completed his medical school in De la Salle University in the Philippines. He finished his Adult Cardiology training and Interventional Cardiology training in St. Luke’s Medical Center Global City. He further trained in Cardiovascular Institute, Tokyo, Japan and in Chang Gung Memorial Hospital, Kaohsiung, Taiwan for peripheral interventions. He also had training in Extracorporeal Membrane Oxygenator (ECMO) management in La Pitie’-Salpetriere University hospital in Paris, France. He is currently an assistent training officer in Interventional Cardiology n his institution. He is a member of the STEMI Committee of the Philippine Society of Cardiac Catheterizations and Interventions.
Acute Coronary Syndromes, particularly ST segment elevation Myocardial Infarction (ACS-STEMI) is highest cause of morbidity and mortality among cardiovascular disease both in developed countries in the west and also in Asia and the Pacific region. Primary angioplastyis the gold standard of therapeutic care and has proven to decrease in-hospital mortality, 30 day mortality, rehospitalizations, heart failure incidence, life thretening arrythmias and improve quality if life among patients. The days of thrombolytic therapy are gone and primary angioplasty is the primary tool to treat such patients in our population. It is a quick, minimally invasive procedure that would save as much myocardium as possible during ACS-STEMI and ESC/AHA recommendations encourage to get patients into the less than 90 minute door-to-open artery time. Established systems and centers even created recommendations to push door-toopen artery time to less than 60 minutes.
This is very ideal in the setting of developed countries with adequate access to cardiac catheterization labs and efficient ambulance service, not to mention adequate health insurance coverage. Countries in the Southeast Asian regions such as Singapore, Thailand, Malaysia and recently Vietnam have been able to establish their nationwide, government supported STEMI systems. The ASEAN population has trend towards increasing incidence of coroanry artery disease similar to the Western and European population. The hub-and-spoke model is an efficient way to channel STEMI patients directly to PCI-capable hospitals and would give such patients proper treatment in collaboration to thrombolytic therapy in far, non-PCI hospitals. The Philippines, with a population of 102 million people, the country being an archipelago or group of islands, as a nation has a very challenging geographical, not to mention economical demographics in terms of formulating a STEMI program bioth in metropolitan and urban/provincial areas. These factors, together with a lack of health insurance coverage and government support in a developing country such as the Philippines had created a very big challenge to health care providers in terms of delivering both efficient thrombolytic therapy and systemised nationwide STEMI program. The author and a group of cardiac interventionists in the country realizing these needs, spearheaded programs within their respective institutions to create STEMI programs and be identified to be “hubs” to “spokes” around Metro Manila (the country’s capital) and a dediated program in the province of Batangas (south of Manila) in the urban setting. The author’s own institution, St. Luke’s Medical Center Global City in Metro Manila, initiated a systemised STEMI program and is the first to launch an efficient 24/7 PCI capability. The system established, with the commitment of 21 rotating interventional cardiologists were able to decrease the door-to-open artery/door-to-balloon time from 156 minutes to 86 minutes in a period of 1 year (2010-2014 (without STEMI system and 2014-2015 (with STEMI system). This commitment and focus on providing efficient primary PCI services 24/7 inspired other PCI capable hospitals in Metro Manila to create their own system as well.