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

Abstract

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.

Validity of regional network systems on reperfusion therapy in diabetes mellitus and non-diabetes mellitus patients with ST-segment elevation myocardial infarction

“…Patients with the following conditions were excluded: (1) AMI occurring in our hospital; (2) chest pain without symptoms or hemodynamic disorder lasting more than 12 h; (3) contraindications for antiplatelet or anticoagulation, such as active peptic ulcer, thrombocytopenia, severe coagulation dysfunction or hemorrhagic disease; (4) severe valvular heart disease, cardiomyopathy, severe infection or severe hepatorenal insufficiency; (5) allergy to contrast agents or stent materials; (6) refusal (of patients or family members) to accept emergency interventional examination; (7) missing information and data on diagnosis and treatment records. (8) Patients in the present study had a first STEMI and admitted within 12 h after symptom onset (FMC-door ≤ 12 h) (12,13). The diagnostic criteria for type 2 DM were typical diabetes symptoms (polydipsia, polyuria, polyphagia or unexplained weight loss) and random venous plasma glucose ≥ 11.1 mmol/L, fasting venous plasma glucose ≥ 7.0 mmol/L or plasma glucose ≥ 11.1 mmol/L 2 h after an oral glucose tolerance test (14).…”

Age shock index and age-modified shock index are valuable bedside prognostic tools for postdischarge mortality in ST-elevation myocardial infarction patients

“…The data of this study were derived from the Henan STEMI registry (NCT 02641262), which was a multicentre, prospective, observational study in central China [ 18 , 19 ]. Patients who met the diagnostic criteria of the universal definition of myocardial infarction (2012) and were hospitalized within 30 days from symptom onset were consecutively enrolled.…”

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

“…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 ].…”