Key result
Reperfusion therapy was associated with significantly lower in-hospital all-cause mortality compared to non-reperfusion (2.1% vs 5.3%, P<0.001) among STEMI patients.
Why the study?
Does reperfusion therapy improve in-hospital mortality compared to conservative management in STEMI patients in Chinese tertiary hospitals, and what are the current treatment delays?
Observational (n=4,191)
Yes
Does reperfusion therapy improve in-hospital mortality compared to conservative management in STEMI patients in Chinese tertiary hospitals, and what are the current treatment delays?
Absolute Event Rate: 2.1% vs 5.3%
p-value: p=< 0.001
In Chinese tertiary hospitals, despite long treatment delays and high rates of self-transport, reperfusion therapy for STEMI is associated with significantly lower in-hospital mortality compared to conservative management.
Supports reperfusion despite delays in Chinese hospitals; leaves open need for RCTs to confirm causality.
BACKGROUND: The China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP) was launched in 2011 to address the problems of insufficient reperfusion and long treatment delay in STEMI care in China. AIM: To describe the baseline status of STEMI emergency care in Tertiary PCI Hospitals using Phase 1 (CSCAP-1) data. DESIGN: CSCAP-1 is a prospective multi-center STEMI registry. METHODS AND RESULTS: A total of 4191 patients with symptom onset within 12 or 12-36 h requiring primary percutaneous coronary intervention (PCI), were enrolled from 53 tertiary PCI hospitals in 14 provinces, municipalities, and autonomous regions of China in CSCAP-1. Among them, 49.0% were self-transported to the hospital, 26.5% were transferred to the hospital by calling the emergency medical services directly, and 24.5% were transferred from other hospitals. In patients with symptom onset within 12 h, 83.2% received primary PCI, 5.9% received thrombolysis and 10.9% received conservative medications. The median door-to-balloon time was 115 (85-170) min and the median door-to-needle time for in-hospital thrombolysis was 80 (50-135) min. The overall in-hospital all-cause mortality was 2.4%, while it was 5.3% in the non-reperfusion group and 2.1% in the reperfusion group (P < 0.001). CONCLUSION: Although a long treatment delay and a high proportion of patients transporting themselves to the hospital were observed, trends were positive with greater adoption of primary PCI and lower in-hospital mortality in tertiary hospitals in China. Our results provided important information for further integrated STEMI network construction in China.
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Zhang et al. (2020) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=4,191). Reperfusion therapy vs. Non-reperfusion was evaluated on In-hospital all-cause mortality (p=< 0.001). Reperfusion therapy was associated with significantly lower in-hospital all-cause mortality compared to non-reperfusion (2.1% vs 5.3%, P<0.001) among STEMI patients.
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