Management of ST-segment elevation myocardial infarction in predominantly rural central China

Abstract

The degree of adherence to current guidelines for clinical management of ST-segment elevation myocardial infarction (STEMI) is known in developed countries and large Chinese cities, but in predominantly rural areas information is lacking. We assessed the application of early reperfusion therapy for STEMI in secondary and tertiary hospitals in Henan province in central China.Data were retrospectively collected from 5 secondary and 4 tertiary hospitals in Henan concerning STEMI patients treated from January 2011 to January 2012, including management strategy, delay time, and inhospital mortality.Among 1311 STEMI patients, 613 and 698 were treated at secondary and tertiary hospitals, respectively. Overall, 460 (35.1%) patients received early reperfusion therapy including thrombolysis in 383 patients and primary percutaneous coronary intervention in 77. Compared with secondary centers, early (37.2% vs 32.6%) and successful reperfusion (34.5% vs 25.1%) was significantly higher, whereas thrombolysis was lower in the tertiary hospitals (26.4% vs 32.5%). Median symptom onset-to-first medical contact, and door-to-needle and door-to-balloon time was 168, 18, and 60 minutes, respectively. Delay times closely approached recommended guidelines, especially in secondary centers. Use of recommended pharmacotherapy was low, particularly in secondary hospitals. Inhospital mortality was 5.8%, and similar between secondary and tertiary hospitals (6.0% vs 5.6%; P = 0.183).Two-thirds of STEMI patients did not receive early reperfusion, and tertiary hospitals mostly failed to take advantage of around-the-clock primary percutaneous coronary intervention. Actions such as referrals are warranted to shorten prehospital delay, and the concerns of patients and doctors regarding reperfusion risk should be addressed.

Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up

“…PHT has the potential to reduce the burden of STEMI related complications in lower‐ and middle‐income countries where timely STEMI treatment is not available. As to‐date there are no randomised controlled trials evaluating the efficacy of PHT for STEMI in lower‐ and middle‐income countries, currently available data can be extrapolated and can help in establishment of systems of care to provide early treatment to the STEMI patients in these areas . Policy makers should consider their local health infrastructure, population distribution needs and should develop guidelines for PHT in light of the internationally available systems and experiences.…”

Changes in process and outcome for ST elevation myocardial infarction in central China from 2011 to 2018

“…At least 10% of randomly selected questionnaires were monitored for accuracy against medical records. [13] The Henan STEMI registry was initiated in 2016, and the design of the registry has been described previously. [14] Briefly, it was a multicenter, prospective, and observational study that aimed to evaluate the characteristics, management, and outcomes of patients with STEMI as observed in routine clinical practice.…”

Rationale and design of the Henan ST elevation myocardial infarction (STEMI) registry: a regional STEMI project in predominantly rural central China

“…In-hospital mortality was 5.8%. Moreover, for patients who didn’t receive reperfusion, doctor’s decision (29%), missed 12-h window (26%), patient refusal (20.4%), and age more than 75 years (15.5%) were main reasons [11, 12].…”