1. The rate of ST-segment elevation myocardial infarctions (STEMI) hospital admissions in China more than quadrupled from 3.7 per 100,000 individuals in 2001 to 15.8 per 100,000 individuals in 2011.
2. Despite increases in treatment intensity, procedures, and testing, the overall mortality from STEMI did not decrease from 2001 to 2011.
Evidence Rating Level: 2 (Good)
Study Rundown: As the population of China has increased in the past two decades, mortality due to ischemic heart disease has more than doubled, with deaths exceeding 1 million per year. However, there have not been any nationally representative studies in China in the past decade to track outcomes, treatment patterns, quality of care, or in-hospital mortality rates for patients admitted to the hospital for ST-segment elevation myocardial infarctions (STEMI). This study sampled 162 hospitals in China and 13,815 hospital admissions for STEMI in 3 different years (2001, 2006, and 2011). The results showed that the estimated national rate for STEMI hospital admissions more than quadrupled from 3.7 per 100,000 individuals in 2001 to 15.8 per 100,000 in 2011. Additionally, the prevalence of significant risk factors, including smoking, hypertension, diabetes, and dyslipidemia, also increased in the same time period. Despite an increase in the use of aspirin within 24 hours and clopidogrel between 2001 and 2011, drugs such as beta-blockers and ACE-inhibitors, which reduce mortality in patients with STEMI, remained underused. Less than half of patients considered as candidates for reperfusion therapy actually received treatment, with no significant change in the proportion over time. Despite an increase in treatment intensity, procedures, and testing, the overall mortality from STEMI did not decrease from 2001 to 2011. These results suggest the need to further improve care for STEMI in China on an evidence-based basis.
This study was funded by the National Health and Family Planning Commission of China and the National Heart, Lung, and Blood Institute.
In-Depth [retrospective analysis]: The China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction (China PEACE-Retrospective AMI Study) tracked data from patients admitted to the hospital with a ST-segment elevation myocardial infarction (STEMI) in 2001, 2006, and 2011.
The rates of hospital admission for STEMI per 100,000 individuals increased from 3.7 in 2001, 8.1 in 2006, to 15.8 in 2011 (p<0.0001). There was an increase in aspirin use within 24 hours from 79.3% (95% Confidence Interval [CI] 77.3-81.3) in 2001 to 91.2% (95% CI 90.5-91.9) in 2011 (p<0.0001), as well as clopidogrel use from 1.5% (95% CI 0.9-2.1) in 2001 to 80.7% (95% CI 79.8–81.6) in 2011 (p<0.0001). Use of primary percutaneous coronary intervention increased between 2001 and 2011 from 10.2% (95% CI 8.1-12.3) to 27.6% (95% CI 26.1-29.1; p<0.0001), while fibrinolytic therapy decreased from 45.0% (95% CI 41.5-48.5) to 27.4% (95% CI 25.9-28.9; p<0.0001). The proportion of patients that did not receive reperfusion did not significantly change (44.8% [95% CI 41.3-48.3] in 2001 vs. 45.0% [43.3–46.7] in 2011, p=0·82). The median hospital stay length decreased from 13 days (interquartile range, IQR 7-18) in 2001, to 11 days (IQR 6-16) in 2006, and 11 days (IQR 7-14) in 2011 (p<0.0001). The adjusted in-hospital mortality did not significantly change between 2001 and 2011 (Odds Ratio 0.84, 95% CI 0.62–1.12, p=0.06).
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