Key result
Primary percutaneous coronary intervention within 12 hours of symptom onset was associated with a significantly decreased risk of in-hospital major adverse cardiovascular events compared with no reperfusion (HR 0.64).
Why the study?
Details of contemporary reperfusion practice and factors associated with reperfusion therapy for STEMI in China were largely unknown.
Does reperfusion therapy (primary PCI or fibrinolysis) reduce in-hospital major adverse cardiovascular events in hospitalized patients with STEMI compared to no reperfusion?
Observational (n=59,447)
Yes
Does reperfusion therapy (primary PCI or fibrinolysis) reduce in-hospital major adverse cardiovascular events in hospitalized patients with STEMI compared to no reperfusion?
Hazard Ratio: 0.64 (95% CI 0.54–0.76)
Absolute Event Rate: 1.72% vs 2.86%
p-value: p=<0.001
In China, while reperfusion rates for STEMI have improved to 69.7% by 2019, significant geographic disparities remain and timely primary PCI is strongly associated with reduced in-hospital MACEs.
BACKGROUND: Reperfusion therapy is fundamental for ST-segment elevation myocardial infarction (STEMI). However, the details of contemporary practice and factors associated with reperfusion therapy in China are largely unknown. Therefore, this study aimed to explore reperfusion practice and its associated factors among hospitalized patients with STEMI in China. METHODS: Patients with STEMI who were admitted to 159 tertiary hospitals from 30 provinces in China were included in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project from November 2014 to December 2019. The associations of the characteristics of patients and hospitals with reperfusion were examined using hierarchical logistic regression. The associations between therapies and in-hospital major adverse cardiovascular events were examined with a mixed effects Cox regression model. RESULTS: Among the 59,447 patients, 37,485 (63.1%) underwent reperfusion, including 4556 (7.7%) receiving fibrinolysis and 32,929 (55.4%) receiving primary percutaneous coronary intervention (PCI). The reperfusion rate varied across geographical regions (48.0%-73.5%). The overall rate increased from 60.0% to 69.7% from 2014 to 2019, mainly due to an increase in primary PCI within 12 h of symptom onset. Timely PCI, but not fibrinolysis alone, was associated with a decreased risk of in-hospital major adverse cardiovascular events compared with no reperfusion, with an adjusted hazard ratio (95% confidence interval) of 0.64 (0.54,0.76) for primary PCI at <12 h, 0.53 (0.37,0.74) for primary PCI at 12 to 24 h, 0.46 (0.25,0.82) for the pharmaco-invasive strategy, and 0.79 (0.54,1.15) for fibrinolysis alone. CONCLUSIONS: Nationwide quality improvement initiatives should be strengthened to increase the reperfusion rate and reduce inequality in China. TRIAL REGISTRATION: www.ClinicalTrials.gov , NCT02306616.
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Yang et al. (2022) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=59,447). Primary percutaneous coronary intervention (<12 h) vs. No reperfusion was evaluated on In-hospital major adverse cardiovascular events (MACEs) (HR 0.64, 95% CI 0.54-0.76, p=<0.001). Primary percutaneous coronary intervention within 12 hours of symptom onset was associated with a significantly decreased risk of in-hospital major adverse cardiovascular events compared with no reperfusion (HR 0.64).
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