Abstract
Abstract Background Statin therapy is among the most effective treatments to improve short-term and long-term mortality after acute myocardial infarction. The use of statin and the intensity of use have not been described in patients with acute myocardial infarction in China, a country with a rapidly growing burden of cardiovascular disease. The aim of this study was to determine rates of statin use and the intensity of statin therapy, defined as those statin regimens expected to lower the concentration of low-density lipoprotein cholesterol by at least 40%, to identify factors associated with the use of statin therapy. Methods In a retrospective analysis of hospital records, we created a nationally representative sample of patients admitted to 162 hospitals all over China for acute myocardial infarction in 3 years (2001, 2006, and 2011), using a two-stage random sampling design. The study population was based on a random sample of patients with acute myocardial infarction, without consideration of equal distribution of sex or other characteristics. The sample size (16 100) of China PEACE-Retrospective Acute Myocardial Infarction Study was determined to gain good precision in estimation of in-hospital mortality of patients admitted for acute myocardial infarction. The analysis of statin therapy use was based on eligible patients who stayed in hospital for more than 24 h without documented contraindication to statin. We used standard statistical methods including Cochran-Armitage test for changing trends and multilevel logistic regression model with generalised estimating equation to identify factors associated with any statin or intensive statin therapy. The central ethics committee at the China National Center for Cardiovascular Diseases approved the study, with a waiver of patients' written consent. This study is registered with ClinicalTrials.gov (identifier NCT01624883). Findings We identified 14 958 patients eligible for statin therapy among 16 100 patients with acute myocardial infarction. Statin use among patients admitted to hospital with acute myocardial infarction increased from 613 (28%) of 2198 patients in 2001 to 3016 (73%) of 2198 patients in 2006 and 7639 (89%) of 4159 patients in 2011 (p trend trend Interpretation The use of statin therapy for Chinese patients with acute myocardial infarction has increased over the past decade. However, half of the patients treated with statin still did not receive intensive statin therapy in 2011. Given that guidelines strongly endorse intensive statin therapy for patients with acute myocardial infarction, initiatives promoting the use of statin therapy, with attention to treatment intensity, would support further improvements in practice. Funding The Research Special Fund for Public Welfare Industry of Health (201202025) from National Health and Family Planning Commission of China. HMK is supported by grant U01 HL105270-04 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute.
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