The temporal trends of incidence, treatment, and in-hospital mortality of acute myocardial infarction over 15years in a Taiwanese population

Yin, Wei Hsian; Lu, Tsung Hsueh; Chen, Kuan Chun; Cheng, Chin Feng; Lee, Jo Chi; Liang, Fu-Wen; Huang, Yu‐Tung; Yang, Li-Tan

doi:10.1016/j.ijcard.2016.02.022

Cited by 42 publications

(29 citation statements)

References 38 publications

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“…A similar contradictory trend has been previously reported in Chinese mainland and Taiwan. [326] By contrast, the mortality of AMI during the same period has continued to decrease in developed western countries. [2728293031] Therefore, there are abundant opportunities for quality improvement in the rural hospitals in Liaoning province.…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

et al. 2017

Chinese Medical Journal

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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.

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Section: Discussionmentioning

confidence: 99%

“…[373839] It has been reported that about half of the decline in MI mortality was due to the primary prevention of an MI (reduction in the proportions of cardiovascular risk factors). [26]…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

et al. 2017

Chinese Medical Journal

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“…Because all patients receiving PCIs in Taiwan were required to be hospitalized for observation, we assessed only the inpatient claims data and not the outpatient claims data. The inpatient claims data comprised data on diagnosis and procedure codes, various service fees, patient characteristics, attending physicians, and hospitals (level of accreditation and ownerships) [11, 12]. This study was approved by the Institutional Review Board of Cheng Hsin General Hospital (CHGH-IRB No.…”

Section: Methodsmentioning

confidence: 99%

Regional and hospital variations in the extent of decline in the proportion of percutaneous coronary interventions performed for nonacute indications – a nationwide population-based study

Liang

et al. 2017

BMC Cardiovasc Disord

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BackgroundThe volume and percentage of percutaneous coronary interventions (PCIs) performed for nonacute indications have declined in the United States since 2007. However, little is known if similar trends occurred in Taiwan.MethodsWe used data from Taiwan National Health Insurance inpatient claims to examine the regional and hospital variations in the extent of decline in the percentage of nonacute indication PCIs from 2007 to 2012.ResultsThe volume of total PCIs persistently increased from 29,032 in 2007 to 35,811 in 2010 and 37,426 in 2012. However, the volume of nonacute indication PCIs first increased from 7916 in 2007 to 9143 in 2009 and then decreased to 8666 in 2012. The percentage of nonacute indication PCIs steadily decreased from 27% in 2007 to 26% in 2009 and then to 23% in 2012, a − 15% change. The extent of decline was largest in the North region (from 27% to 21%, a − 22% change) and least in Kaopin region (from 20% to 18%, a − 13% change). Of the 71 hospitals studied, 14 did not show a decreasing trend. Five of the 14 hospitals even showed an increasing trend, with a percentage change >10% between 2007 and 2012. In 2012, 6 hospitals had a nonacute indication PCI percentage >35%.ConclusionsIn Taiwan, four-fifths of the hospitals showed a decline in the percentage of nonacute indication PCIs from 2007 to 2012. It is plausible that Taiwanese cardiologists would have been influenced by the recommendations of crucial US trials and guidelines.

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“…[1] Since the foundation of clinical guidelines for AMI management, [2] hospitalization and in-hospital mortality rates have significantly declined in recent decades. [3–5] However, the prognosis of patients after AMI requires improvement.…”

Section: Introductionmentioning

confidence: 99%

Glycated hemoglobin level is an independent predictor of major adverse cardiac events after nonfatal acute myocardial infarction in nondiabetic patients

Chen¹,

Yen

Lin³

et al. 2017

Medicine

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The effect of glycemic control on the prognosis of nondiabetic patients after acute myocardial infarction (AMI) remains uncertain. We investigated whether glycated hemoglobin (HbA1c) is associated with adverse outcomes after AMI in nondiabetic patients. In this observational study, we enrolled nondiabetic patients with AMI in the emergency department of 2 medical centers from January 2011 to September 2014. All patients received primary percutaneous coronary intervention and were divided into 4 groups according to the interquartile range of average HbA1c level (Group I, ≤5.6%; Group II, 5.6%–5.8%; Group III, 5.8%–6.0%; and Group IV, >6.0%). Multivariate logistic analysis was performed to estimate the correlation of HbA1c with major adverse cardiac events (MACEs) after AMI. In total, 267 eligible patients were enrolled; 48 patients (18%) developed MACEs within a median follow-up of 178 days. Univariate analysis showed HbA1c > 6.0%, with a higher risk of MACEs in Group IV than in Group I (odds ratio [OR]: 2.733; 95% confidence interval [CI]: 1.123–6.651 vs OR: 1.511; 95% CI: 0.595–3.835). Multivariate analysis revealed an approximately 3.8 times higher risk of MACEs in Group IV than in Group I (OR: 3.769; 95% CI: 1.30–10.86). The HbA1 level is a significant predictor of MACEs after AMI in nondiabetic patients.

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The temporal trends of incidence, treatment, and in-hospital mortality of acute myocardial infarction over 15years in a Taiwanese population

Cited by 42 publications

References 38 publications

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

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

Regional and hospital variations in the extent of decline in the proportion of percutaneous coronary interventions performed for nonacute indications – a nationwide population-based study

Glycated hemoglobin level is an independent predictor of major adverse cardiac events after nonfatal acute myocardial infarction in nondiabetic patients

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