Trends in Cardiac Biomarker Testing in China for Patients with Acute Myocardial Infarction, 2001 to 2011: China PEACE-Retrospective AMI Study

Abstract

ObjectivesTo describe trends in the availability of biomarker testing in Chinese hospitals and how practice complies with established standards for the diagnosis of acute myocardial infarction (AMI).BackgroundCardiac biomarker testing is standard in high-income countries, but little is known about the availability and use of cardiac biomarker testing in low- and middle-income countries (LMICs) such as China.MethodsBased on a nationally representative sample of Chinese hospitals in 2001, 2006 and 2011, we describe the temporal trends and regional differences in the hospital capability and rates of use of cardiac biomarker testing, as well as the variation in use across hospitals with testing capability, for patients labeled with the diagnosis of AMI.ResultsWe sampled 175 hospitals (162 participated in the study) and 18,631 AMI admissions. 14,370 patients were included in analysis of biomarker use. The proportion of hospitals with biomarker testing capability was 57.4% in 2001 (25.0% troponin and 32.4% creatine kinase MB fraction (CK-MB) only) and 96.3% (81.4% troponin and 14.9% CK-MB only) in 2011. The proportion of hospitals with troponin testing capability in 2011 was significantly higher in urban compared with rural hospitals (96.8% vs. 71.4%, p< 0.001). In 2011, only 55.9% of hospitals with troponin testing capability (71 out of 127 hospitals) used the assay for more than 80% of their patients with AMI. Among hospitals with either biomarker testing capability, there was marked variation in use in both rural (from 7.1% to 100.0% of patients) and urban hospitals (from 57.9% to 100.0% of patients). In 2011, 36.1% of the patients with AMI did not have troponin tested and 4.9% did not have either biomarker measured.ConclusionsThe recommended biomarker tests for AMI diagnosis are not universally available and the testing is not consistently applied when it is available in China.Trial RegistrationClinicalTrials.gov NCT01624883

Changes in ST segment elevation myocardial infarction hospitalisations in China from 2011 to 2015

“…Regarding epidemiology, we note that from 2011 to 2015, non-ST segment elevation myocardial infarction (NSTEMI) cases as a proportion of all AMI cases increased, continuing the trend observed between 2001 and 2011. As we have previously reported, this is likely due to both an increased use of sensitive biomarkers for myocardial injury in China, 10 which would increase the diagnoses of NSTEMI, 11 as well as a concomitant change in the Chinese population at risk of AMI. 12 Despite increasing numbers of NSTEMI, the predominant AMI presentation in China continues to be STEMI, in contrast to high-income countries.…”

Recent Trends in Hospitalization for Acute Myocardial Infarction in Beijing

“… 2 , 4 , 13 Cardiac troponins have been introduced for the diagnosis of AMI in China since 2001 and widely available in urban cities in 2006. 25 Moreover, previous studies reported that implementation of troponin classified an additional 26% to 58% of patients as having AMI compared with traditional enzymatic markers. 26 , 27 Therefore, the use of troponins may not solely explain the three-fold increase in NSTEMI.…”

Simple risk score based on the China Acute Myocardial Infarction registry for predicting in-hospital mortality among patients with non-ST-segment elevation myocardial infarction: results of a prospective observational cohort study

“…Approximately 18.6% of hospitals do not have the capability to examine the troponin level in China. Even among hospitals with troponin-level testing capabilities, only 55.9% use the assay for >80% of patients with AMI 17. Similarly, many patients may not have available data on the creatinine level at initial presentation.…”