1 Qanitha A, et al. BMJ Open 2018;8:e021996. doi:10.1136/bmjopen-2018-021996 Open access Characteristics and the average 30-day and 6-month clinical outcomes of patients hospitalised with coronary artery disease in a poor South-East Asian setting: the frst cohort from Makassar Cardiac Center, Indonesia Andriany Qanitha, 1,2 Cuno S P M Uiterwaal, 3 Jose P S Henriques, 4 Abdul Hakim Alkatiri, 5 Idar Mappangara, 5 Ali Aspar Mappahya, 5 Ilhamjaya Patellongi, 2 Bastianus A J M de Mol 1 To cite: Qanitha A, Uiterwaal CSPM, Henriques JPS, et al. Characteristics and the average 30-day and 6-month clinical outcomes of patients hospitalised with coronary artery disease in a poor South- East Asian setting: the frst cohort from Makassar Cardiac Center, Indonesia. BMJ Open 2018;8:e021996. doi:10.1136/ bmjopen-2018-021996 ► Prepublication history and additional material for this paper are available online. To view these fles, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2018- 021996). The abstract of this manuscript has been presented in the American Heart Association (AHA) scientifc event 2017, 11 November to 15 November 2017, in Anaheim, California, USA, and published in Circulation, 14 November 2017, Volume 136, Issue Suppl 1: A20914. Received 31 January 2018 Revised 12 April 2018 Accepted 11 May 2018 For numbered affliations see end of article. Correspondence to Andriany Qanitha; a.qanitha@amc.uva.nl; myaqanitha@gmail.com Research ABSTRACT Objective To provide a detailed description of characteristics at hospital admission and clinical outcomes at 30-day and 6-month follow-up in patients hospitalised with coronary artery disease (CAD) in a poor South-East Asian setting. Design Prospective observational cohort study. Setting From February 2013 to December 2014, in Makassar Cardiac Center, Indonesia. Participants 477 patients with CAD (acute coronary syndrome and stable CAD). Outcome measures All-cause mortality and major adverse cardiovascular events (MACE). Results Out of 477 patients with CAD, the proportion of young age (<60 years) was 53.9% and 72.7% were male. At admission, 44.2% of patients were diagnosed with ST- segment elevation myocardial infarction (STEMI), 38.6% with diagnosis or signs of heart failure and 75.1% had previous hypertension. Out of 211 patients with STEMI, only 4.7% had been treated with primary percutaneous coronary intervention (PCI) and 6.2% received thrombolysis. The time lapse from symptom onset to hospital admission was 26.8 (IQR 10.0–48.0) hours, and 19.1% of all patients had undergone either PCI or coronary artery bypass graft. The survival rate at 6 months was 78.9%. The rates of all-cause mortality at 30 days and 6 months were 13.4% and 7.3%, respectively; the rate of composite MACE at 30 days was 26.2% and 18.0% at 6 months. Conclusions Patients with CAD from a poor South-East Asian setting present themselves with predominantly unstable conditions of premature CAD. These patients show relatively severe illness, have signifcant time delay from symptom onset to admission or intervention, and most do not receive the guidelines-recommended treatment. Awareness of symptoms, prompt initial management of acute CVD, well-established infrastructures and resources both in primary and secondary hospital for CVD should be improved to reduce the high rates of 30-day and 6-month mortality and adverse outcomes in this population. INTRODUCTION   The South-East Asia region, which accounts for one-quarter of the world’s population and 40% of the global poor, is facing a rapid epidemiological transition. 1 This leads to the high rates of premature death from non-com- municable diseases (NCD), primarily from cardiovascular disease (CVD). 2 Of the 7.9 million annual NCD in this region, 34% occur before the age of 60 years compared with 16% in the European region and 23% in the rest of the world. 2 Half of the world’s cardiovascular burden is estimated to occur in Asia, 3 and the prevalence of symptomatic heart failure appears to be higher in South- East Asia countries compared with the rest of Strengths and limitations of this study ► This is the frst study that fully reports on charac- teristics at admission as well as the short-term and mid-term outcomes of patients with coronary artery disease (CAD) in Indonesia. ► We completed, to the best of our ability, the fol- low-up of this study by actively visiting patients’ houses or contacting their family members to obtain outcomes data. ► Diversity on places of origin in our cohort represents the population in Indonesia, and generally rep- resents a population in South-East Asia with limited resources. ► Due to geographical and distance constraints, fol- low-up was completed by telephone in half of this cohort. ► We excluded all patients with normal coronary angi- ography, and therefore our study might overlook the minor group of non-obstructive CAD.