Trends in the Use of Guideline-Recommended Medications and In-Hospital Mortality of Patients with Acute Myocardial Infarction in a Chinese Population

Abstract

ObjectiveCurrent practice guidelines recommend the routine use of several cardiac medications early in the course of acute myocardial infarction (AMI). Our objective was to analyze temporal trends in medication use and in-hospital mortality of AMI patients in a Chinese population.MethodsThis is a retrospective observational study using electronic medical records from the hospital information system (HIS) of 14 Chinese hospitals. We identified 5599 patients with AMI between 2005 and 2011. Factors associated with medication use and in-hospital mortality were explored by using hierarchical logistic regression.ResultsThe use of several guideline-recommended medications all increased during the study period: statins (57.7%–90.1%), clopidogrel (61.8%–92.3%), β-Blockers (45.4%–65.1%), ACEI/ARB (46.7%–58.7%), aspirin (81.9%–92.9%), and the combinations thereof increased from 24.9% to 42.8% (P<0.001 for all). Multivariate analyses showed statistically significant increases in all these medications. The in-hospital mortality decreased from 15.9% to 5.7% from 2005 to 2011 (P<0.001). After multivariate adjustment, admission year was still a significant factor (OR = 0.87, 95% CI 0.79–0.96, P = 0.007), the use of aspirin (OR = 0.64, 95% CI 0.46–0.87), clopidogrel (OR = 0.44, 95% CI 0.31–0.61), ACEI/ARB (OR = 0.73, 95% CI 0.56–0.94) and statins (OR = 0.54, 95% CI 0.40–0.73) were associated with a decrease in in-hospital mortality. Patients with older age, cancer and renal insufficiency had higher in-hospital mortality, while they were generally less likely to receive all these medications.ConclusionUse of guideline-recommended medications early in the course of AMI increased between 2005 and 2011 in a Chinese population. During this same time, there was a decrease in in-hospital mortality.

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

“…In‐hospital and 30‐day mortality rates for AMI patients in these studies ranged from 4.54% to 10.1% and from 6% to 16.1%, respectively 6, 8, 15, 48, 49, 50, 51. Even within China, region‐, province‐, and hospital‐level IHM rates vary in studies using sampled data 24, 52. These differences in AMI patients’ outcomes suggest an urgent need for timely, nationwide statistics for AMI in China to assist policy makers.…”

“…6,8,15,[48][49][50][51] Even within China, region-, province-, and hospital-level IHM rates vary in studies using sampled data. 24,52 These differences in AMI patients' outcomes suggest an urgent need for timely, nationwide statistics for AMI in China to assist policy makers. In our study, which used routinely collected discharge data for AMI patients, the national IHM rate was 4.71%, with the lowest rate in the North (3.60%) and the highest in the Northeast (6.44%).…”

“…First, although we controlled for multiple confounding factors, we cannot eliminate the possibility of unmeasured or unknown confounders affecting rates of IHM and PCI use for AMI patients. Second, different combinations of ICD-10 or ICD-9-CM codes were used to identify a disease or procedure in previous studies, such as our combination of I21 and I22 25,37,38,50 and I21 alone 24,60,61 for AMI and our combination of 00.66, 36.03 to 04, 36.06 to 07, and 36.09 39 or several different combinations of 00.66, 36.01 to 02, 36.05 to 07, and 36.09 16,25,51,53 for PCI. These choices may affect the identification of AMI, STEMI or NSTEMI, and Charlson comorbidities, as well as PCI use.…”

“…22 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 hospitals [24][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.…”

Systematic review and meta-analysis of the prognostic impact of cancer among patients with acute coronary syndrome and/or percutaneous coronary intervention

“…Moreover malignancy is associated with the risk of stent thrombosis [23]. Finally, patients with cancer are less likely to receive optimal guideline recommended medications [9,11,24]. The use of early invasive strategy, and PCI if needed, is associated with improved outcome after ACS [25,26].…”