Recent Trends in Hospitalization for Acute Myocardial Infarction in Beijing

Zhang, Qian; Zhao, Dong; Xie, Weixin; Xie, Xin; Guo, Moning; Wang, Miao; Wang, Wei; Liu, Wanru; Liu, Jing

doi:10.1097/md.0000000000002677

Cited by 57 publications

(29 citation statements)

References 33 publications

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“…Inhospital mortality in our study was lower than other trials in China, [13,14,29] possibly because of the following reasons. First and most importantly, inhospital mortality is not the primary outcome in the sample size estimation, so the sample size is too small to calculate the inhospital mortality.…”

Section: Discussioncontrasting

confidence: 75%

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

et al. 2016

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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.

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Section: Discussioncontrasting

confidence: 75%

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

et al. 2016

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“… 15 Similarly, Zhang et al studied 77,943 Chinese AMI patients in Beijing between 2001 and 2012; AMI rates increased over time by 31.2% from 55.8 to 73.3 per 100,000 population. 16 Although there was a decrease in STEMI, there was a threefold increase in the rate of NSTEMI.…”

Section: Introductionmentioning

confidence: 98%

Acute myocardial infarction in young women: current perspectives

Chandrasekhar¹,

Gill²,

Mehran³

2018

IJWH

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Acute myocardial infarction (AMI) is the leading cause of death in women worldwide. Every year, in the USA alone, more than 30,000 young women <55 years of age are hospitalized with AMI. In recent decades, the incidence of AMI is increasing in younger women in the context of increasing metabolic syndrome, diabetes mellitus, and non-traditional risk factors such as stress, anxiety, and depression. Although women are classically considered to present with atypical chest pain, several observational data confirm that men and women experience similar rates of chest pain, with some differences in intensity, duration, radiation, and the choice of descriptors. Women also experience more number of symptoms and more prodromal symptoms compared with men. Suboptimal awareness, sociocultural and financial reasons result in pre-hospital delays in women and lower rates of access to care with resulting undertreatment with guideline-directed therapies. Causes of AMI in young women include plaque-related MI, microvascular dysfunction or vasospasm, and spontaneous coronary artery dissection. Compared with men, women have greater in-hospital, early and late mortality, as a result of baseline comorbidities. Post-AMI women have lower referral to cardiac rehabilitation with more dropouts, lower levels of physical activity, and poorer improvements in health status compared with men, with higher inflammatory levels at 1-year from index presentation. Future strategies should focus on primary and secondary prevention, adherence, and post-AMI health-related quality of life. This review discusses the current evidence in the epidemiology, diagnosis, and treatment of AMI in young women.

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“…Identifying the determinants of IHM and PCI use among AMI patients is likely to be important in developing targeted interventions to improve access to PCI and to reduce AMI mortality 23. Previous studies, however, used data from a specific region or selected hospitals24, 25, 26, 27, 28 or focused on patients with ST‐segment–elevation myocardial infarction (STEMI) 29, 30, 31, 32, 33, 34. Given the marked geographic, economic, demographic, and cultural diversity in China, a nationwide investigation using representative samples is needed.…”

Section: Introductionmentioning

confidence: 99%

Geographic Variations in In‐Hospital Mortality and Use of Percutaneous Coronary Intervention Following Acute Myocardial Infarction in China: A Nationwide Cross‐Sectional Analysis

Chen

Shi

Xue

et al. 2018

JAHA

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BackgroundPrevalence of acute myocardial infarction (AMI) is increasing in China, and AMI has become a major cause of mortality; however, information is very limited about the nationwide geographic and hospital variation in in‐hospital mortality (IHM) and the use of percutaneous coronary intervention (PCI) after AMI.Methods and ResultsFrom the Nationwide Hospital Discharge Database of China, we identified 242 866 adult admissions with AMI in 2015 from 1055 tertiary hospitals. We used multivariable logistic regressions to analyze the associations between geographic or hospital characteristics with IHM or PCI use. The national IHM rate was 4.71% (95% confidence interval, 4.62–4.79%). There was a greater risk of mortality in the Northeast (odds ratio [OR]: 1.86), West (OR: 1.73), South (OR: 1.32), and North (OR: 1.14) regions than in the East region of China. Non–teaching hospitals (OR: 1.18) and tertiary level B hospitals (OR: 1.06) were associated with higher IHM rates. The national PCI use rate was 45.3% (95% confidence interval, 45.1–45.5%). Compared with the East region of China, PCI use was lower in the Northeast (OR: 0.50), West (OR: 0.64), North (OR: 0.84), and South (OR: 0.88) regions. Non–teaching hospitals (OR: 0.83) and tertiary level B hospitals (OR: 0.55) were also associated with lower usage rates. There was a significant negative correlation between IHM and PCI use (r=−0.955), and IHM rates for patients with and without PCI both differed by geographic regions.ConclusionsThere were significant differences in IHM and PCI use among China's tertiary hospitals, linked to both geographic and hospital characteristics. More targeted intervention at national and regional levels is needed to improve access to effective health technologies and, eventually, outcomes following AMI.

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Recent Trends in Hospitalization for Acute Myocardial Infarction in Beijing

Abstract: Supplemental Digital Content is available in the text

Cited by 57 publications

References 33 publications

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

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

Acute myocardial infarction in young women: current perspectives

Geographic Variations in In‐Hospital Mortality and Use of Percutaneous Coronary Intervention Following Acute Myocardial Infarction in China: A Nationwide Cross‐Sectional Analysis

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