Key result
Management of AMI after the 2001 Chinese guidelines was associated with lower rates of in-hospital death (6.4% vs 9.4%, P=0.038), heart failure, and angina compared to prior management.
Why the study?
Does the implementation of the 2001 Chinese AMI guidelines improve in-hospital outcomes in patients with AMI?
Cohort (n=1,783)
No
Does the implementation of the 2001 Chinese AMI guidelines improve in-hospital outcomes in patients with AMI?
Absolute Event Rate: 6.4% vs 9.4%
p-value: p=0.038
The introduction of the 2001 Chinese AMI guidelines was associated with increased use of evidence-based therapies and significantly reduced in-hospital mortality and heart failure.
Supports guideline-directed AMI care in similar settings; leaves open whether benefits are causal or generalizable beyond this cohort.
BACKGROUND: The first Chinese guidelines for the diagnosis and management of patients with acute myocardial infarction (AMI) were issued by the Cardiovascular Branch of the Chinese Medical Association, the Editorial Board of the Chinese Journal of Cardiology, and the Editorial Board of the Chinese Circulation Journal in December 2001. However, it is still unclear whether these guidelines have produced a major impact on clinical practice and patient outcomes. The purpose of this study was to evaluate the impact of these guidelines on the management and prognosis of Chinese patients with AMI. METHODS: A retrospective study was carried out in patients with AMI who were admitted to Qilu Hospital of Shandong University from January 1994 to December 2004. Patients were divided into two groups: group A included patients admitted from January 1994 to December 2001, and group B comprised those admitted from January 2002 to December 2004. Therapeutic approaches and the occurrence rate of angina pectoris, reinfarction, heart failure and death during hospitalization were compared between two groups. RESULTS: A total of 1783 patients including 1208 cases in group A and 575 cases in group B were enrolled in this study. No significant difference was found in baseline characteristics between group A and group B patients (all P > 0.05). There were more patients undergoing reperfusion therapy within the first 24 hours after symptom onset in group B than in group A (35.8% vs 21.7%, P < 0.001). Administration of beta-blockers, angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), statins, and heparins were more commonly seen in group B than in group A (P < 0.001). There were no significant differences in the use of nitrates or antiplatelet drugs between groups A and B (98.8% vs. 97.9%, P = 0.172, and 97.4% vs 98.6%, P = 0.113, respectively). In-hospital angina pectoris, heart failure and death were all lower in group B than in group A (32.2% vs 41.2%, P < 0.001; 17.2% vs 26.2%, P < 0.001; and 6.4% vs 9.4%, P = 0.038, respectively). There was no significant difference in the rate of reinfarction between group A and B patients (2.2% vs 1.7%, P = 0.492). CONCLUSIONS: Chinese guidelines for the management of patients with AMI issued in December 2001 resulted in changes in therapy that led to a significant improvement of in-hospital outcomes but not in the rate of reinfarction in patients with AMI.
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Jiang et al. (2006) conducted a cohort in Acute myocardial infarction (n=1,783). Management after 2001 Chinese AMI guidelines (2002-2004) vs. Management before guidelines (1994-2001) was evaluated on In-hospital death (p=0.038). Management of AMI after the 2001 Chinese guidelines was associated with lower rates of in-hospital death (6.4% vs 9.4%, P=0.038), heart failure, and angina compared to prior management.
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