PMID- 37545028
OWN - NLM
STAT- MEDLINE
DCOM- 20230921
LR  - 20230922
IS  - 2542-5641 (Electronic)
IS  - 0366-6999 (Print)
IS  - 0366-6999 (Linking)
VI  - 136
IP  - 18
DP  - 2023 Sep 20
TI  - Changes in process and outcome for ST elevation myocardial infarction in central 
      China from 2011 to 2018.
PG  - 2203-2209
LID - 10.1097/CM9.0000000000002698 [doi]
AB  - BACKGROUND: Limited data are available on the changes in the quality of care for 
      ST elevation myocardial infarction (STEMI) during China's health system reform 
      from 2009 to 2020. This study aimed to assess the changes in care processes and 
      outcome for STEMI patients in Henan province of central China between 2011 and 
      2018. METHODS: We compared the data from the Henan STEMI survey conducted in 
      2011-2012 ( n = 1548, a cross-sectional study) and the Henan STEMI registry in 
      2016-2018 ( n = 4748, a multicenter, prospective observational study). Changes in 
      care processes and in-hospital mortality were determined. Process of care 
      measures included reperfusion therapies, aspirin, P2Y12 antagonists, beta-blockers, 
      angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and 
      statins. Therapy use was analyzed among patients who were considered ideal 
      candidates for treatment. RESULTS: STEMI patients in 2016-2018 were younger 
      (median age: 63.1 vs . 63.8 years) with a lower proportion of women (24.4% 
      [1156/4748] vs . 28.2% [437/1548]) than in 2011-2012. The composite use rate for 
      guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% 
      [5424/8901] vs . 82.7% [22,439/27,129], P <0.001). The proportion of patients 
      treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% 
      (2698/3440) ( P <0.001) with a prolonged median onset-to-first medical contact 
      time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, 
      statins, and beta-blockers increased significantly. The risk of in-hospital 
      mortality significantly decreased over time (6.1% [95/1548] vs . 4.2% [198/4748], 
      odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.50-0.88, P = 0.005) after 
      adjustment. CONCLUSIONS: Gradual implementation of the guideline-recommended 
      treatments in STEMI patients from 2011 to 2018 has been associated with decreased 
      in-hospital mortality. However, gaps persist between clinical practice and 
      guideline recommendation. Public awareness, reperfusion strategies, and 
      construction of chest pain centers need to be further underscored in central 
      China.
CI  - Copyright (c) 2023 The Chinese Medical Association, produced by Wolters Kluwer, 
      Inc. under the CC-BY-NC-ND license.
FAU - Zhang, You
AU  - Zhang Y
AD  - Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, 
      Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan 451464, China.
AD  - Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan 451464, China.
AD  - Henan Key Laboratory for Prevention and Control of Coronary Heart Disease, 
      Central China Fuwai Hospital, Zhengzhou, Henan 451464, China.
FAU - Wang, Shan
AU  - Wang S
AD  - Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, 
      Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan 451464, China.
AD  - Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan 451464, China.
AD  - Henan Key Laboratory for Prevention and Control of Coronary Heart Disease, 
      Central China Fuwai Hospital, Zhengzhou, Henan 451464, China.
FAU - Qi, Datun
AU  - Qi D
AD  - Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, 
      Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan 451464, China.
AD  - Henan Key Laboratory for Prevention and Control of Coronary Heart Disease, 
      Central China Fuwai Hospital, Zhengzhou, Henan 451464, China.
FAU - Wang, Xianpei
AU  - Wang X
AD  - Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, 
      Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan 451464, China.
AD  - Henan Key Laboratory for Prevention and Control of Coronary Heart Disease, 
      Central China Fuwai Hospital, Zhengzhou, Henan 451464, China.
FAU - Li, Muwei
AU  - Li M
AD  - Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, 
      Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan 451464, China.
AD  - Henan Key Laboratory for Prevention and Control of Coronary Heart Disease, 
      Central China Fuwai Hospital, Zhengzhou, Henan 451464, China.
FAU - Zhu, Zhongyu
AU  - Zhu Z
AD  - Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, 
      Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan 451464, China.
AD  - Henan Key Laboratory for Prevention and Control of Coronary Heart Disease, 
      Central China Fuwai Hospital, Zhengzhou, Henan 451464, China.
FAU - Cheng, Qianqian
AU  - Cheng Q
AD  - Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, 
      Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan 451464, China.
AD  - Henan Key Laboratory for Prevention and Control of Coronary Heart Disease, 
      Central China Fuwai Hospital, Zhengzhou, Henan 451464, China.
FAU - Hu, Dayi
AU  - Hu D
AD  - Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan 451464, China.
AD  - Institute of Cardiovascular Disease, Peking University People's Hospital, Beijing 
      100044, China.
FAU - Gao, Chuanyu
AU  - Gao C
AD  - Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, 
      Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan 451464, China.
AD  - Henan Institute of Cardiovascular Epidemiology, Zhengzhou, Henan 451464, China.
AD  - Henan Key Laboratory for Prevention and Control of Coronary Heart Disease, 
      Central China Fuwai Hospital, Zhengzhou, Henan 451464, China.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20230804
PL  - China
TA  - Chin Med J (Engl)
JT  - Chinese medical journal
JID - 7513795
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - R16CO5Y76E (Aspirin)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Adrenergic beta-Antagonists)
SB  - IM
MH  - Humans
MH  - Female
MH  - Middle Aged
MH  - *ST Elevation Myocardial Infarction/drug therapy
MH  - *Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
MH  - Cross-Sectional Studies
MH  - Aspirin/therapeutic use
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Hospital Mortality
MH  - Registries
MH  - Treatment Outcome
MH  - *Percutaneous Coronary Intervention
PMC - PMC10508564
COIS- None.
EDAT- 2023/08/07 06:41
MHDA- 2023/09/21 06:42
PMCR- 2023/09/20
CRDT- 2023/08/07 00:13
PHST- 2022/12/31 00:00 [received]
PHST- 2023/09/21 06:42 [medline]
PHST- 2023/08/07 06:41 [pubmed]
PHST- 2023/08/07 00:13 [entrez]
PHST- 2023/09/20 00:00 [pmc-release]
AID - 00029330-202309200-00009 [pii]
AID - CMJ-2021-2881 [pii]
AID - 10.1097/CM9.0000000000002698 [doi]
PST - ppublish
SO  - Chin Med J (Engl). 2023 Sep 20;136(18):2203-2209. doi: 
      10.1097/CM9.0000000000002698. Epub 2023 Aug 4.