Key result
Increased primary PCI and evidence-based therapies fail to reduce 7-day STEMI mortality.
Why the study?
Trends in clinical characteristics, treatments, and outcomes for hospitalized STEMI patients in eastern urban China from 2001 to 2011 were not well characterized.
Observational (n=5,257)
Yes
Absolute Event Rate: 6.1% vs 7.8%
p-value: p=>0.05
Despite increased adoption of guideline-directed medical therapies and primary PCI for STEMI in eastern urban China between 2001 and 2011, short-term mortality did not significantly improve.
Rising therapy adoption failed to lower short-term STEMI mortality; leaves open implementation barriers and unmeasured factors in similar settings.
OBJECTIVE: To assess trends in clinical characteristics, treatments, and outcomes for hospitalized patients with ST-segment elevation myocardial infarction(STEMI) in eastern urban China from 2001 to 2011. METHODS: The data were obtained from the China PEACE-retrospective acute myocardial infarction study. Patients admitted to hospital in the eastern urban China for STEMI were selected via two-stage random sampling. The first phase was to identify participating hospitals via a simple random-sampling procedure. The second stage was to select patients admitted to each participating hospitals for acute myocardial infarction in the year of 2001, 2006 and 2011 with a systematic sampling approach. Then clinical information was obtained via central medical record abstraction for each patient. In all analyses, weight was calculated proportional to the inverse sampling fraction for each period. Multilevel logistic regression models with generalized estimating equations were used for analysis of patient outcomes. RESULTS: This analysis included 5 257 patients with STEMI from 32 hospitals. In 2001, 2006, and 2011, the median age of STEMI patients was 66(57, 72)、67(56, 74)and 63(53, 74)years(trend test P=0.008), the proportion of female was 30.3%, 29.5% and 29.2%(trend test P=0.530), respectively. The proportion of cardiovascular risk factors increased over time(trend test P<0.001); 45.6%, 55.6%, and 56.3% patients had hypertension(trend test P<0.001); 18.8%, 27.7% and 26.2% patients had diabetes(trend test P<0.001); 50.1%, 59.2% and 70.5% patients had dyslipidemia(trend test P<0.001); 30.5%, 35.1% and 44.1% patients are current smokers(trend test P<0.001) in 2001, 2006 and 2011, respectively. Between 2001 and 2011, there were significant increases in aspirin use(80.7% in 2001, 90.4% in 2006, and 91.5% in 2011, trend test P<0.001), clopidogrel use(2.9% in 2001, 64.2% in 2006, and 90.3% in 2011, trend test P<0.001) within 24 hours after admission, statins use rate was 45.8% in 2001, 83.4% in 2006, and 93.8% in 2011(trend test P<0.001), and rate of direct percutaneous coronary intervention(PCI) was 21.0% in 2001, 29.7% in 2006, and 40.3% in 2011(trend test P<0.001) in patients without documented contraindications. However, the rate of reperfusion therapy was non-significantly decreased: 58.5% in 2001, 58.0% in 2006, and 55.5% in 2011 (trend test P=0.230). The use of beta blockers also decreased: 62.4% in 2001, 64.3% in 2006 and 55.2% in 2011(trend test P=0.001). The mortality rate within 7 days following admission was 7.8%, 7.0%, 6.1%, and the proportion of death or treatment withdrawal because of terminal status was 8.3%, 8.6%, 7.4% in 2001, 2006 and 2011, respectively. Both parameters were similar among the 3 time points(trend test P>0.05). CONCLUSIONS: During the past decade, there has been a rapid increase in application of new technology and drug for STEMI in the eastern urban China. However, important gaps persist between clinical practice and guideline recommendations, and the outcomes of patients have not been significantly improved. Clinical Trail Registry: ClinicalTrials.gov, NCT01624883.
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Li et al. (2016) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=5,257). Admission year (2001 to 2011) vs. 2001 (baseline) was evaluated on Mortality rate within 7 days following admission (p=>0.05). Despite increased use of evidence-based therapies and primary PCI for STEMI in eastern urban China from 2001 to 2011, 7-day mortality did not significantly improve (7.8% in 2001 vs 6.1% in 2011; P>0.05).