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

Zhang, You; Wang, Shan; Yang, Shuyan; Yin, Shanshan; Cheng, Qingyuan; Li, Muwei; Qi, Datun; Wang, Xianpei; Zhu, Zhongyu; Zhao, Luosha; Hu, Dayi; Gao, Chuanyu

doi:10.1186/s12872-019-1250-9

Cited by 8 publications

(7 citation statements)

References 28 publications

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“…Data in the present study were derived from two observational studies: 2011-2012 data from a cross-sectional survey, using a randomized and stratified cluster sampling design to enroll 17 hospitals (8 tertiary hospitals and 9 secondary hospitals) in Henan, [13] and 2016-2018 data from a prospective registration study, which enrolled 5479 patients with STEMI in 66 hospitals covering 15 of 17 prefectures in Henan. [14] Both the studies tried to represent the STEMI patients in secondary and tertiary hospitals in Henan in terms of design methods and regional coverage, had the same purpose of assessing the process and outcome in secondary and tertiary hospitals, and adopted strict quality control. Therefore, comparison of the results of the two studies could reveal the changes in STEMI treatment process and outcome in Henan province from 2011 to 2018.…”

Section: Discussionmentioning

confidence: 99%

“…[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. The registry enrolled 5479 patients with STEMI in 66 (50 secondary and 16 tertiary) hospitals in Henan from September 2016 to August 2018.…”

Section: Study Population and Data Collectionmentioning

confidence: 99%

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

Zhang,

Wang,

et al. 2023

Chinese Medical Journal

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Background: Limited data are available on the changes in the quality of care for ST elevation myocardial infarction (STEMI) during China's health system reform from 2009 to 2020. We aimed to assess the changes in care processes and outcome for STEMI patients in Henan province of central China between 2011 and 2018. Methods: We compared the data from the Henan STEMI survey conducted in 2011–2012 (n = 1548, a cross-sectional study) and the Henan STEMI registry in 2016–2018 (n = 4748, a multicenter, prospective observational study). Changes in care processes and in-hospital mortality were determined. Process of care measures included reperfusion therapies, aspirin, P2Y12 antagonists, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were considered ideal candidates for treatment. Results: STEMI patients in 2016–2018 were younger (median age: 63.1 vs. 63.8 years) with a lower proportion of women (24.4% [1156/4748] vs. 28.2 [437/1548]) than in 2011–2012. The composite use rate for guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% [5424/8901] vs. 82.7% [22,439/27,129], P <0.001). The proportion of patients treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% (2698/3440) (P <0.001) with a prolonged median onset-to-first medical contact time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, statins, and β-blockers increased significantly. The risk of in-hospital mortality significantly decreased over time (6.1% [95/1548] vs. 4.2% [198/4748], OR: 0.67, 95% CI: 0.50–0.88, P = 0.005) after adjustment. Conclusions: Gradual implementation of the guideline-recommended treatments in STEMI patients from 2011 to 2018 has been associated with decreased in-hospital mortality. However, gaps persist between clinical practice and guideline recommendation. Public awareness, reperfusion strategies, and construction of chest pain centers need to be further underscored in central China.

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Section: Discussionmentioning

confidence: 99%

Section: Study Population and Data Collectionmentioning

confidence: 99%

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

Zhang,

Wang,

et al. 2023

Chinese Medical Journal

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“…Data for this study were obtained from the Henan STEMI registry study (Unique identifier: NCT 02641262), which enrolled patients admitted with a definitive diagnosis of STEMI between September 2016 and August 2018, at 66 centers (50 secondary hospitals, 16 tertiary hospitals) from different geographic regions of central China (Henan province). The registry study has been registered at URL: https://www.clinicaltrials.gov , and the design has been described previously [ 17 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

Sex Disparity in Characteristics, Management, and In-Hospital Outcomes of Patients with ST-Segment Elevated Myocardial Infarction: Insights from Henan STEMI Registry

Wang

Zhang

Cheng

et al. 2022

Cardiology Research and Practice

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Background. Women hospitalized with ST-elevation myocardial infarction (STEMI) experience higher risk of early mortality than men. We aimed to investigate the potential impact of risk factors, clinical characteristics, and management among gender-related risk differences. Method. We analyzed 5063 STEMI patients prospectively enrolled from 66 hospitals during 2016–2018 and compared sex differences in mortality, death, or treatment withdrawal and main adverse cardiovascular and cerebrovascular events (MACCE) using the generalized linear mixed model, following sequential adjustment for covariates. Results. Women were older and had a higher prevalence of hypertension (53.3% vs. 41.1%, P < 0.001 ) and diabetes (24.5% vs. 15.2%, P < 0.001 ). Eligible women were less likely to receive reperfusion therapy (56.1% vs. 62.4%, P < 0.001 ); the onset to first medical contact (FMC) (255 vs. 190 minutes, P < 0.001 ), onset to fibrinolysis (218 vs. 185 minutes, P < 0.001 ), and onset to percutaneous coronary intervention (PCI) (307 vs. 243 minutes, P < 0.001 ) were significantly delayed in women. The incidence of in-hospital death (6.8% vs. 3.0%, P < 0.001 ), death or treatment withdrawal (14.5% vs. 5.6%, P < 0.001 ), and MACCE (18.5% vs. 9.4%, P < 0.001 ) were notably higher. The gender disparities persist in death (OR: 1.61, 95% CI: 1.12–2.33), death or treatment withdrawal (OR: 1.68, 95% CI: 1.26–2.24), and MACCE (OR: 1.37, 95% CI: 1.08–1.74) after adjustment for covariates. Among possible explanatory factors, age (−58.46%, −59.04%, −62.20%) and cardiovascular risk factors (−40.77%, −39.36%, −41.73%) accounted for most of the gender-associated risk differences. Conclusions. Women experienced worse in-hospital outcomes, and age and cardiovascular risk factors were major factors influencing sex-related differences. The sex disparity stressed the awareness and importance of quality improvement efforts against female patients in clinical practice.

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“…The design of Henan STEMI registry has been described previously. 14 Briefly, it is a multicentre, prospective, and observational study aimed to evaluate the characteristics, management and outcomes of patients with STEMI as seen in routine clinical practice. Only secondary and tertiary hospitals are reperfusion capable, which are located in three levels of Chinese local government-province, prefecture and county.…”

Section: Methodsmentioning

confidence: 99%

Reperfusion strategy and in-hospital outcomes for ST elevation myocardial infarction in secondary and tertiary hospitals in predominantly rural central China: a multicentre, prospective and observational study

et al. 2021

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ObjectivesTo assess differences in reperfusion treatment and outcomes between secondary and tertiary hospitals in predominantly rural central China.DesignMulticentre, prospective and observational study.SettingSixty-six (50 secondary and 16 tertiary) hospitals in Henan province, central China.ParticipantsPatients with ST elevation myocardial infarction (STEMI) within 30 days of symptom onset during 2016–2018.Primary outcome measuresIn-hospital mortality, and in-hospital death or treatment withdrawal.ResultsAmong 5063 patients of STEMI, 2553 were treated at secondary hospitals. Reperfusion (82.0% vs 73.0%, p<0.001) including fibrinolytic therapy (70.3% vs 4.4%, p<0.001) were more preformed, whereas primary percutaneous coronary intervention (11.7% vs 68.6%, p<0.001) were less frequent at secondary hospitals. In secondary hospitals, 53% received fibrinolytic therapy 3 hours after onset, and 5.8% underwent coronary angiography 2–24 hours after fibrinolysis. Secondary hospitals had a shorter onset-to-first-medical-contact time (176 min vs 270 min, p<0.001). Adjusted in-hospital mortality (adjusted OR 1.23, 95% CI 0.89 to 1.70, p=0.210) and in-hospital death or treatment withdrawal (adjusted OR 1.18, 95% CI 0.82 to 1.70, p=0.361) were similar between secondary and tertiary hospitals.ConclusionsWith fibrinolytic therapy as the main reperfusion strategy, the reperfusion rate was higher in secondary hospitals, whereas in-hospital outcomes were similar compared with tertiary hospitals. Public awareness, capacity of primary and secondary care institutes to treat STEMI, and establishment of deeper cooperation among different-level healthcare institutes need to further improve.Trial registration numberNCT02641262.

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

Cited by 8 publications

References 28 publications

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

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

Sex Disparity in Characteristics, Management, and In-Hospital Outcomes of Patients with ST-Segment Elevated Myocardial Infarction: Insights from Henan STEMI Registry

Reperfusion strategy and in-hospital outcomes for ST elevation myocardial infarction in secondary and tertiary hospitals in predominantly rural central China: a multicentre, prospective and observational study

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