Abstract 10950: Real-World Practice of Reperfusion and Revascularization in Patients with St-Segment Elevation Myocardial Infarction in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project

Abstract

Introduction: Reperfusion and revascularization therapies are key treatments of ST-segment elevation myocardial infarction (STEMI). However, little is known about the contemporary practice among Chinese patients with STEMI. We aimed to explore the recent practice of reperfusion and revascularization among hospitalized patients with STEMI in China. Methods: A total of 59442 STEMI patients admitted to 159 tertiary hospitals from 30 provinces in China were included in the Improving Care for Cardiovascular Disease in China (CCC)-ACS project from November 2014 to December 2019. The practice of reperfusion and revascularization were assessed. Associations between therapies and in-hospital MACE after 1 day of admission were examined with multivariate Cox regression. Results: Among the 59442 patients, 48897 (82.3%) underwent reperfusion/ revascularization, including 28280 (47.6%) received pPCI within 12 hours, 4649 (7.8%) received pPCI between 12 to 24 hours, 1314 (2.2%) received fibrinolysis alone, and 1751 (2.9%) received pharmaco-invasive strategy. A total of 12903 patients (21.7%) received elective PCI, among which 1486 (11.5%) initially received fibrinolysis. Overall, 37480 patients (63.1%) received reperfusion therapy, including 32929(55.4%) received pPCI, which was 7.2-fold higher than that of fibrinolysis (4551, 7.7%). Among patients receiving fibrinolysis, only 38.4% (1751/4551) received pharmaco-invasive strategy, including 25.2% for pharmaco-invasive PCI and 13.3% for rescue PCI. All PCI strategies, but not fibrinolysis alone, were associated with decreased risk of in-hospital MACE compared with no reperfusion/ revascularization, with the adjusted HR (95% CI) of 0.46(0.38, 0.56) for pPCI<12h, 0.38(0.27, 0.55) for pPCI 12-24h, 0.38(0.16, 0.95) for rescue PCI, 0.27(0.13, 0.59) for pharmaco-invasive PCI, 0.28(0.21, 0.37) for elective PCI, and 0.86(0.57, 1.29) for fibrinolysis alone. Conclusions: Revascularization therapies are widely used in patients with STEMI in China. However, there are notable gaps between guideline recommendations and the clinical practice in terms of timely reperfusion, especially pharmaco-invasive strategy. Early reperfusion therapies should be further strengthened.