Changes in ST segment elevation myocardial infarction hospitalisations in China from 2011 to 2015

Abstract

ObjectiveAccess to acute cardiovascular care has improved and health services capacity has increased over the past decades. We assessed national changes in (1) patient characteristics, (2) in-hospital management and (3) patient outcomes among patients presenting with ST segment elevation myocardial infarction (STEMI) in 2011–2015 in China.MethodsIn a nationally representative sample of hospitals in China, we created two random cohorts of patients in 2011 and 2015 separately. We weighted our findings to estimate nationally representative numbers and assessed changes from 2011 to 2015. Data were abstracted from medical charts centrally using standardised definitions.ResultsWhile the proportion of patients with STEMI among all patients with acute myocardial infarction decreased over time from 82.5% (95% CI 81.7 to 83.3) in 2011 to 68.5% (95% CI 67.7 to 69.3) in 2015 (p<0.0001), the weighted national estimate of patients with STEMI increased from 210 000 to 380 000. The rate of reperfusion eligibility among patients with STEMI decreased from 49.3% (95% CI 48.1 to 50.5) to 42.2% (95% CI 41.1 to 43.4) in 2015 (p<0.0001); ineligibility was principally driven by larger proportions with prehospital delay exceeding 12 hours (67.4%–76.7%, p<0.0001). Among eligible patients, the proportion receiving reperfusion therapies increased from 54% (95% CI 52.3 to 55.7) to 59.7% (95% CI 57.9 to 61.4) (p<0.0001). Crude and risk-adjusted rates of in-hospital death did not differ significantly between 2011 and 2015.ConclusionsIn this most recent nationally representative study of STEMI in China, the use of acute reperfusion increased, but no significant improvement occurred in outcomes. There is a need to continue efforts to prevent cardiovascular diseases, to monitor changes in in-hospital treatments and outcomes, and to reduce prehospital delay.

The abnormal level and prognostic potency of multiple inflammatory cytokines in PCI‐treated STEMI patients

“…ST‐segment elevation myocardial infarction (STEMI), defined as ST‐segment elevation in two anatomically contiguous leads, is the most urgent manifestation of coronary artery disease 1,2 . Over the past decade, the number of new STEMI cases is increasing in China annually, meanwhile, its mortality is constant 3 . Concerning the STEMI treatment, for patients with symptom onset within 12 h, percutaneous coronary intervention (PCI) is the preferred strategy to restore myocardial perfusion as soon as possible 4–6 .…”

Number of standard modifiable risk factors and mortality in patients with first-presentation ST-segment elevation myocardial infarction: insights from China Acute Myocardial Infarction registry

“…In this study, we observed that the proportion was a little bit lower in China (11.8%), with the estimate comparable to that in the China PEACE-Retrospective Acute Myocardial Infarction Study (9.7%) [ 21 ]. Moreover, the China PEACE study even reported a significant decrease in the proportion of patients with no SMuRFs at the time of admission from 2011 to 2015 (11 to 5.5%) [ 16 , 21 ]. Nevertheless, considering the total number of STEMI patients almost nearly doubled in China at the same period [ 16 ], there was a substantial absolute number of patients presenting life-threatening STEMI without any SMuRF who cannot benefit from primary prevention strategies.…”

“…Our subgroup analysis stratified by hospital levels also supports this hypothesis that the adjusted association was less pronounced in province-level or prefecture-level hospitals compared with county-level hospitals although the interactive effect was not significant. Therefore, it is critical to improve the quality of the medical care system in these developing countries like China, especially for those remote areas with limited medical resources and low public awareness of ACS [ 15 , 16 , 32 ].…”

“…Moreover, current evidence is predominantly from highly developed countries, where patients can homogeneously receive high-quality emergency medical service and standardized evidence-based clinical management [ 7 – 14 ], whereas, in China, a large proportion of patients might experience long pre-hospital delays and suboptimal medical care, especially in those low-level hospitals and remote areas [ 15 ]. A recent study even reported that the rate of reperfusion eligibility decreased among patients with STEMI from 2011 to 2015 in China, which was majorly driven by the increased prevalence of long pre-hospital delay [ 16 ]. Thus, it is important to evaluate the clinical profiles and outcomes of patients with different numbers of SMuRFs in such a complex setting.…”

Risk factors and prediction nomogram model for 1-year readmission for major adverse cardiovascular events in patients with STEMI after PCI

“…The proportion of women was much lower than that of men who were hospitalized for STEMI (28.1 vs 71.9%, P < 0.001), consistent with what had been reported in the literature. 17 However, once STEMI occurs, women usually have a higher risk of readmission than men, regardless of whether PCI was performed. 11 Our study also confirmed sex-based differences, with 2.4 times higher risk of readmission of female survivors than male survivors (OR = 2.426; 95% CI: 1.395–4.218; P = 0.002).…”