Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province

Abstract

Background:Since 2010, two versions of National Guidelines aimed at promoting the management of ST-segment elevation myocardial infarction (STEMI) have been formulated by the Chinese Society of Cardiology. However, little is known about the changes in clinical characteristics, management, and in-hospital outcomes in rural areas.Methods:In the present multicenter, cross-sectional study, participants were enrolled from rural hospitals located in Liaoning province in Northeast China, during two different periods (from June 2009 to June 2010 and from January 2015 to December 2015). Data collection was conducted using a standardized questionnaire. In total, 607 and 637 STEMI patients were recruited in the 2010 and 2015 cohorts, respectively.Results:STEMI patients in rural hospitals were older in the second group (63 years vs. 65 years, P = 0.039). We found increases in the prevalence of hypertension, prior percutaneous coronary intervention (PCI), and prior stroke. Over the past 5 years, the cost during hospitalization almost doubled. The proportion of STEMI patients who underwent emergency reperfusion had significantly increased from 42.34% to 54.47% (P < 0.0001). Concurrently, the proportion of primary PCI increased from 3.62% to 10.52% (P < 0.0001). The past 5 years have also seen marked increases in the use of guideline-recommended drugs and clinical examinations. However, in-hospital mortality and major adverse cardiac events did not significantly change over time (13.01% vs. 10.20%, P = 0.121; 13.34% vs. 13.66%, P = 0.872).Conclusions:Despite the great progress that has been made in guideline-recommended therapies, in-hospital outcomes among rural STEMI patients have not significantly improved. Therefore, there is still substantial room for improvement in the quality of care.

The dose-response association between estimated glomerular filtration rate and prognosis of patients with ST-segment elevation myocardial infarction from rural areas of China's Liaoning province

“…In this multicenter study, STEMI patients were recruited by 2 stages. As previously described elsewhere, [23] 12 secondary hospitals located in rural areas of China's Liaoning province were randomly sampled in the first stage (June 2009 to June 2010). All patients presenting with STEMI at those hospitals were consecutively enrolled.…”

<p>Nicorandil prior to primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials</p>

“…Early myocardial reperfusion by primary percutaneous coronary intervention (PCI) has become an important treatment strategy for patients with ST-segment elevated myocardial infarction (STEMI), which is associated with reduced infarct size, preserved cardiac function and improved clinical outcomes in these patients 1,2. However, despite effective reperfusion by PCI, a considerable proportion of patients with STEMI still have impaired cardiac function and increased cardiovascular mortality 3,4. It has been demonstrated that coronary microvascular dysfunction and obstruction, which occur in almost half of STEMI patients after primary PCI, are important causes of subsequent deterioration of cardiac function and poor prognosis in these patients 5,6.…”

Sex-Related Differences in Short- and Long-Term Outcome among Young and Middle-Aged Patients for ST-Segment Elevation Myocardial Infarction Underwent Percutaneous Coronary Intervention

“…Despite a significant decrease in mortality associated with cardiovascular disease in developed countries over the last decade,[ 1 2 ] acute myocardial infarction (AMI) continues to be a major cause of morbidity and mortality. [ 3 4 ] ST-segment elevation myocardial infarction (STEMI) constitutes more than 80% of MI patients in China;[ 5 ] percutaneous coronary intervention (PCI) is the established acute reperfusion therapy for STEMI. [ 6 ] STEMI remains the major contributor to death in females who suffer from cardiovascular disease at an older age compared with males,[ 7 8 9 ] with females being reported to have more risk factors.…”