Acute Myocardial Infarction In China Research Articles

RhPro-UK in acute ischemic stroke within 4.5 h of stroke onset trial-2 (the PROST-2 study): Rationale and design of a multicenter, prospective, randomized, open-label, blinded-endpoint, controlled phase 3 non-inferiority trial.

Recombinant prourokinase (rhPro-UK) is a specific plasmin activator, which has been approved to treat acute myocardial infarction in China. This phase 3 trial aimed to further demonstrate the efficacy and safety of rhPro-UK in patients with acute ischemic stroke (AIS) within 4.5 h of symptom onset. RhPro-UK in AIS within 4.5 h of stroke onset trial-2 (PROST-2) is a multicenter, prospective randomized, open-label, blinded end-point, non-inferiority, recombinant tissue plasmin activator (rt-PA)-controlled, phase 3 trial. A total of 1552 patients who are eligible for intravenous thrombolytic therapy from 72 clinical sites will be randomly assigned to receive either rhPro-UK 35 mg (15 mg bolus + 20 mg infusion/30 min) or rt-PA 0.9 mg/kg (10% bolus + 90% infusion/1 h). The primary outcome is the proportion of patients with a modified Rankin Scale (mRS) score of 0-1 at 90 days. Secondary efficacy outcomes include the proportion of patients with mRS score of 0-2, the distribution of mRS, self-care ability in daily life on the Barthel Index at 90 days, the proportion of subjects with ⩾ 4 points decrease in National Institutes of Health Stroke Scale (NIHSS) score or NIHSS score ⩽ 1 from baseline at 24 h and 7 days after treatment. Safety outcomes are symptomatic intracranial hemorrhage (sICH) and major systematic bleeding within 7 days as well as death from all causes within 90 days. The results from the PROST-2 trial will comprehensively elucidate the efficacy and safety profile of rhPro-UK as a potential alternative agent for stroke thrombolysis. URL: http://www.clinicaltrials.gov. Unique identifier: NCT05700591.

Methodology and results of cost-effectiveness of LDL-C lowering with evolocumab in patients with acute myocardial infarction in China

BackgroundAccording to the Chinese guidelines for lipid management (2023), evolocumab in combination with statins was recommended as secondary prevention of cardiovascular disease. However, because of the variation in the price of evolocumab and its different methods of confirming clinical efficacy, it was necessary to explore its economics and the impact of different methods of confirming efficacy on its economic studies.ObjectiveThe purpose of this paper was to assess the cost-effectiveness of evolocumab with statins versus statins alone for patients with acute myocardial infarction(AMI) in China and to investigate the impact of different clinical effectiveness modeling approaches on economic outcomes.MethodsA Markov cohort state-transition model was used to estimate the incremental cost-effectiveness ratio (ICER) based on Chinese observational data on cardiovascular event rates, efficacy from the Asian subgroup of the FOURIER trial, cost and utility from the Chinese Yearbook of Health Statistics, health insurance data, and published studies conducted in China. This study conducted subgroup analyses for different populations and dosing regimens; sensitivity analyses for parameters such as cost, utility, and cardiovascular event rates; and scenario analyses on hospital hierarchy, time horizon, starting age, and price for statins.ResultsICERs ranged from 27423 to 214777 Chinese yuan(CNY) per QALY gained, all below the willingness-to-pay threshold of CNY 257094. Only when the time horizon became small, the ICERs were greater than the willingness-to-pay. The probabilities that adding evolocumab to statins was cost-effective ranged from 76 to 98%. When the time horizon became small, i.e. evolocumab was discontinued before the age of 75 (after conversion), the corresponding ICERs were almost always greater than the willingness-to-pay. ICERs for modelling approaches based on clinical endpoints were 1.34 to 1.95 times higher than ICERs for modelling approaches based on reduced LDL-C levels.ConclusionsFrom the Chinese healthcare and private payer perspectives, adding evolocumab to statin therapy in AMI patients is more likely to be a cost-effective treatment option at the current list price of CNY 283.8. However, evolocumab may not be cost-effective if used for shorter periods of time. The results based on different clinical effectiveness modeling approaches were significantly different.

Inter-hospital transfer in patients with acute myocardial infarction in China: Findings from the improving care for cardiovascular disease in China-acute coronary syndrome project.

Little is known about the current scenario of inter-hospital transfer for patients with acute myocardial infarction (AMI) in China. From November 2014 to December 2019, 94,623 AMI patients were enrolled from 241 hospitals in 30 provinces in China. We analyzed the pattern of inter-hospital transfer, and compared in-hospital treatments and outcomes between transferred patients and directly admitted patients. Of these patients, 40,970 (43.3%) were transferred from hospitals that did not provide percutaneous coronary intervention (PCI). The proportion of patients who were transferred from non-PCI hospital was 46.3% and 11.9% (P < 0.001) in tertiary hospitals and secondary hospitals, respectively; 56.2% and 37.3% (P < 0.001) in hospitals locating in low-economic regions and affluent areas, respectively. Compared with directly admitted patients, transferred patients had lower rates of reperfusion for STEMI (57.8% vs. 65.2%, P < 0.001) and timely PCI for NSTEMI (34.7%vs. 41.1%, P < 0.001). The delay for STEMI patients were long, with 6.5h vs. 4.5h from symptom onset to PCI for transferred and directly admitted patients, respectively. The median time-point was 9 days for in-hospital outcomes. Compared with direct admission, the hazard ratios and 95% confidence intervals associated with inter-hospital transfer were 0.87 (0.75-1.01) and 0.87 (0.73-1.03) for major adverse cardiovascular events and total mortality, respectively, in inverse probability of treatment weighting models in patients with STEMI, and 1.02 (0.71-1.48) and 0.98 (0.70-1.35), respectively, in patients with NSTEMI. More than 40% of the hospitalized AMI patients were transferred from non-PCI-capable hospitals in China. Further strategies are needed to enhance the capability of revascularization and reduce the inequality in management of AMI.

Development and validation of a risk prediction model for post-traumatic stress disorder symptoms in patients with acute myocardial infarction in China.

At present, there are many influencing factors of post-traumatic stress disorder (PTSD) symptoms in patients with acute myocardial infarction (AMI), but based on this, there are few studies on the risk prediction model of PTSD symptoms. The aim of this study was to investigate the risk factors of PTSD symptoms in patients with AMI and to construct a risk prediction model. From April 2021 to March 2022, 287 patients were enrolled from a hospital in Shandong Province, China. According to the PTSD Checklist (PCL-C) scores 30 days after discharge, the participants were divided into a PTSD symptoms group (92 cases) and a non-PTSD symptoms group (195 cases). The demographic data, disease factors, treatment factors, and laboratory examination indicators were compared between the 2 groups; independent risk factors were screened out, and a risk prediction model was constructed by logistic regression. Area under the curve (AUC) was used as the internal verification of the model prediction. From April 2022 to June 2022, 72 patients with AMI in a hospital in Shandong Province were selected. PCL-C data were collected 30 days after discharge, and finally external validation of the model was performed. Five factors, including gender [odds ratio (OR) =3.325], diabetes history (OR =2.292), creatine kinase isozyme (OR =1.046), insomnia score (OR =2.045), and fear of disease progression score (OR =1.126) were included to construct the risk prediction model. According to the Hosmer-Lemeshow test, P=0.785. The AUC was 0.910, the maximum value of Youden index was 0.751, the sensitivity was 0.870, the specificity was 0.881, and the accuracy rate of practical application was 67.64%. The risk prediction model of PTSD symptoms in patients with AMI established in this study is consistent and effective. It can provide a reference for clinical assessment of PTSD symptoms risk in patients with AMI.

Pre-hospital delay in patients with acute myocardial infarction in China: findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project.

OBJECTIVETo describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction (AMI) in China.METHODSData were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project. A total of 33,386 patients with AMI admitted to the index hospitals were included in this study. Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes.RESULTSOf the 33,386 patients with AMI, 70.7% of patients arrived at hospital ≥ 2 h after symptom onset. Old age, female, rural medical insurance, symptom onset at early dawn, and non-use of an ambulance predicted a prolonged pre-hospital delay (all P < 0.05). Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-segment elevation myocardial infarction (STEMI) (all P < 0.05). A pre-hospital delay of ≥ 2 h was associated with an increased risk of mortality [odds ratio (OR) = 1.36, 95% CI: 1.09–1.69, P = 0.006] and major adverse cardiovascular events (OR = 1.22, 95% CI: 1.02–1.47, P = 0.033) in patients with STEMI compared with a pre-hospital delay of < 2 h. CONCLUSIONSProlonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China. Our study identifies that patient characteristics, symptom onset time, and type of transportation are associated with pre-hospital delay time, and provides focuses for quality improvement.

A Novel Risk Score to Predict In-Hospital Mortality in Patients With Acute Myocardial Infarction: Results From a Prospective Observational Cohort.

ObjectivesThe aim of this study was to develop and validate a novel risk score to predict in-hospital mortality in patients with acute myocardial infarction (AMI) using the Heart Failure after Acute Myocardial Infarction with Optimal Treatment (HAMIOT) cohort in China.MethodsThe HAMIOT cohort was a multicenter, prospective, observational cohort of consecutive patients with AMI in China. All participants were enrolled between December 2017 and December 2019. The cohort was randomly assigned (at a proportion of 7:3) to the training and validation cohorts. Logistic regression model was used to develop and validate a predictive model of in-hospital mortality. The performance of discrimination and calibration was evaluated using the Harrell’s c-statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. The new simplified risk score was validated in an external cohort that included independent patients with AMI between October 2019 and March 2021.ResultsA total of 12,179 patients with AMI participated in the HAMIOT cohort, and 136 patients were excluded. In-hospital mortality was 166 (1.38%). Ten predictors were found to be independently associated with in-hospital mortality: age, sex, history of percutaneous coronary intervention (PCI), history of stroke, presentation with ST-segment elevation, heart rate, systolic blood pressure, initial serum creatinine level, initial N-terminal pro-B-type natriuretic peptide level, and PCI treatment. The c-statistic of the novel simplified HAMIOT risk score was 0.88, with good calibration (Hosmer–Lemeshow test: P = 0.35). Compared with the Global Registry of Acute Coronary Events risk score, the HAMIOT score had better discrimination ability in the training (0.88 vs. 0.81) and validation (0.82 vs. 0.72) cohorts. The total simplified HAMIOT risk score ranged from 0 to 121. The observed mortality in the HAMIOT cohort increased across different risk groups, with 0.35% in the low risk group (score ≤ 50), 3.09% in the intermediate risk group (50 < score ≤ 74), and 14.29% in the high risk group (score > 74).ConclusionThe novel HAMIOT risk score could predict in-hospital mortality and be a valid tool for prospective risk stratification of patients with AMI.Clinical Trial Registration[https://clinicaltrials.gov], Identifier: [NCT03297164].

Development and validation of a novel risk score to predict 5-year mortality in patients with acute myocardial infarction in China: a retrospective study.

BackgroundThe disease burden from ischaemic heart disease remains heavy in the Chinese population. Traditional risk scores for estimating long-term mortality in patients with acute myocardial infarction (AMI) have been developed without sufficiently considering advances in interventional procedures and medication. The goal of this study was to develop a risk score comprising clinical parameters and intervention advances at hospital admission to assess 5-year mortality in AMI patients in a Chinese population.MethodsWe performed a retrospective observational study on 2,722 AMI patients between January 2013 and December 2017. Of these patients, 1,471 patients from Changsha city, Hunan Province, China were assigned to the development cohort, and 1,251 patients from Xiangtan city, Hunan Province, China, were assigned to the validation cohort. Forty-five candidate variables assessed at admission were screened using least absolute shrinkage and selection operator, stepwise backward regression, and Cox regression methods to construct the C2ABS2-GLPK score, which was graded and stratified using a nomogram and X-tile. The score was internally and externally validated. The C-statistic and Hosmer-Lemeshow test were used to assess discrimination and calibration, respectively.ResultsFrom the 45 candidate variables obtained at admission, 10 potential predictors, namely, including Creatinine, experience of Cardiac arrest, Age, N-terminal Pro-Brain Natriuretic Peptide, a history of Stroke, Statins therapy, fasting blood Glucose, Left ventricular end-diastolic diameter, Percutaneous coronary intervention and Killip classification were identified as having a close association with 5-year mortality in patients with AMI and collectively termed the C2ABS2-GLPK score. The score had good discrimination (C-statistic = 0.811, 95% confidence intervals (CI) [0.786–0.836]) and calibration (calibration slope = 0.988) in the development cohort. In the external validation cohort, the score performed well in both discrimination (C-statistic = 0.787, 95% CI [0.756–0.818]) and calibration (calibration slope = 0.976). The patients were stratified into low- (≤148), medium- (149 to 218) and high-risk (≥219) categories according to the C2ABS2-GLPK score. The predictive performance of the score was also validated in all subpopulations of both cohorts.ConclusionThe C2ABS2-GLPK score is a Chinese population-based risk assessment tool to predict 5-year mortality in AMI patients based on 10 variables that are routinely assessed at admission. This score can assist physicians in stratifying high-risk patients and optimizing emergency medical interventions to improve long-term survival in patients with AMI.

Gender differences in cardiovascular risk factors in patients with acute myocardial infarction in China

Objective: To understand gender differences of cardiovascular risk factors in patients with acute myocardial infarction (AMI) in China. Methods: A total of 26 592 patients with AMI from 107 hospitals in 31 provinces in China from January 1, 2013 to September 30, 2014 were included. Self-designed questionnaire was used to collect patients' age, gender, height, weight, type of AMI, medical history of cardiovascular and cerebrovascular diseases, medication history, lifestyle and AMI risk factors, including high blood pressure, diabetes, dyslipidemia, overweight and/or obesity, smoking history and family history of early onset coronary artery disease. A total of 24 394 patients with complete clinical data were included in the analysis, and gender differences in cardiovascular risk factors were analyzed in all and subgroups with different characteristics. Results: The patients were (62.2±13.8) years old, including 18 162 (74.5%) males and 18 209 (74.6%) ST-segment elevation myocardial infarction (STEMI). The age of male patients was (60.2±13.7) years, which was younger than that of female patients [(68.2±12.3) years]. The body mass index of male patients was (24.2±3.0) kg/m2, which was higher than that of female patients [(23.8±3.4) kg/m2]. The proportions of patients with overweight and/or obesity, smoking history, dyslipidemia, family history of early onset coronary heart disease, fatty diet and history of AMI were 51.8%, 55.2%, 7.2%, 3.8%, 80.4% and 7.7%, which were higher than those of females (45.9%, 9.9%, 5.8%, 2.3%, 65.0% and 5.9%, respectively]. The proportions of hypertension, diabetes, physical inactivity and stroke history were 46.5%, 17.2%, 77.8% and 8.5%, respectively, which were lower than those in female patients [61.4% (3 829 cases), 24.8%, 81.7% and 11.1%, respectively] (all P values<0.05).The proportions of peripheral vascular diseases history in male and female patients were 0.6% and 0.7%, respectively, with no statistical significance in difference (P>0.05). Subgroup analysis showed inconsistent results comparing to analysis of all patients: there were no statistical significance in gender differences as for the proportion of dyslipidemia in the non-ST-segment elevation MI group, the proportion of family history of early onset coronary heart disease in the young and middle aged groups, the proportion of overweight and/or obesity, and the proportion of physical inactivity in the elderly group (all P values>0.05). Conclusions: There are gender differences in cardiovascular risk factors among Chinese patients with acute myocardial infarction. Hypertension and diabetes are more common in women, and overweight and/or obesity, fatty diet and smoking are more common in men.

Abstract 10198: Association Between Admission Low-Density Lipoprotein Cholesterol and In-Hospital Mortality Among Inpatients with Acute Myocardial Infarction in China: Findings from CCC-ACS Project

Introduction: Lowering low-density lipoprotein cholesterol (LDL-C) to &lt;1.4 mmol/L is an important strategy for most patients with acute myocardial infarction (AMI) in secondary prevention of cardiovascular diseases. The association between admission LDL-C levels and all-cause mortality during acute period of AMI is not well established. This study aims to examine the relation between admission LDL-C levels and the risk of in-hospital all-cause mortality among patients with AMI. Methods: The Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project is a nationwide registry study. Admission LDL-C level associated with in-hospital all-cause mortality were evaluated on a continuous scale with restricted cubic splines and by categories with multivariate Cox regression models among 94623 inpatients with AMI in 159 tertiary hospitals and 82 secondary hospitals in 30 provinces from November 2014 to December 2019. Results: Among total inpatients, 1852 cases (2.0%) died, 5434 patients (5.7%) have LDL-C level&lt;1.4 mmol/L. The association between LDL-C levels and the risk of all-cause mortality was U shaped, with low and high LDL-C levels associated with an increased risk. Compared with inpatients with LDL-C level of 1.4-1.8 mmol/L, the adjusted hazard ratio was 1.48 (95% confidence interval: 1.18 to 1.87) for patients with LDL-C&lt; 1.4 mmol/L, and 1.50 (95%CI: 1.19 to 1.90) for patients with LDL-C≥ 4.1 mmol/L. Propensity score matched analysis confirmed these associations. Similar results were seen in both gender, in patients with and without diabetes, across age groups and triglycerides groups, across ST-segment elevation AMI and non-ST-segment elevation AMI patients, and after excluding patients who died within 24 hours after admission. However, such association was not observed in patients received lipid-lowering treatment before hospitalization and those treated with percutaneous coronary intervention during hospitalization. Conclusions: Lower LDL-C is associated with increased risk of in hospital all-cause mortality among patients hospitalized for AMI. Lower LDL-C levels may help identify patients at higher risk for in-hospital mortality, who could potentially benefit from intensification of treatment strategies.

Abstract 10840: Direct Admission versus Inter-Hospital Transfer of Hospitalized Patients with Acute Myocardial Infarction in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project

Introduction: Although percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for AMI, a substantial proportion of patients initially arrive at non-PCI hospitals. The impact of direct admission to a PCI-capable hospital and inter-hospital transfer on prognosis of AMI with relatively long ischemia time in real-world practice is still debated. We aimed to compare the in-hospital outcomes associated with direct admission versus inter-hospital transfer of hospitalized patients with AMI in China. Methods: From November 2014 to December 2019, 94,623 patients with AMI were enrolled from 159 tertiary hospitals and 82 secondary hospitals in 30 provinces in China in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) Project. Patients were divided into those directly admitted or inter-hospital transferred to a PCI hospital. Associations of direct admission versus inter-hospital transfer with in-hospital major adverse cardiovascular events (MACE) were examined by multivariable Cox regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) analysis. Results: Among the 94,623 patients, 53,653 (56.7%) were directly admitted to PCI hospitals, and 40,970 (43.3%) were inter-hospital transferred. Compared with inter-hospital transfer, direct admission was associated with a shorter time from symptom onset to reperfusion (6.0h vs.9.8h for STEMI and 54.4h vs.83.3h for NSTEMI), and higher rates of reperfusion for STEMI (63.4% vs. 50.7%) and timely PCI for NSTEMI (41.1% vs. 34.7%). No significant associations were found between direct admission relative to inter-hospital transfer and the risk of in-hospital MACE in Cox regression (HRs [95%CIs] were 1.17 [0.95-1.42] for STEMI and 0.81 [0.55-1.19] for NSTEMI), in PSM (1.17 [0.94-1.45] for STEMI and 0.79 [0.49-1.27] for NSTEMI), and in IPTW analysis (1.22 [0.95-1.58] for STEMI and 0.87 [0.55-1.37] for NSTEMI). Conclusions: There was no significant difference in the risk of in-hospital MACE between directly admitted and transferred patients with AMI in China. Therefore, when direct admission is not feasible, timely transfer to PCI-capable hospitals maybe an alternative in real-world practice.

Development and validation of a risk prediction model for in-hospital major cardiovascular events in patients hospitalised for acute myocardial infarction

ObjectivesPatients admitted to hospital with acute myocardial infarction (AMI) have considerable variability in in-hospital risks, resulting in higher demands on healthcare resources. Simple risk-assessment tools are important for the identification...

Randomized Controlled Trials on Roy Adaptation Model Nursing in Patients with Acute Myocardial Infarction in China: A Systematic Review

Randomized Controlled Trials on Roy Adaptation Model Nursing in Patients with Acute Myocardial Infarction in China: A Systematic Review

Appropriateness of gastrointestinal prophylaxis use during hospitalization in patients with acute myocardial infarction: Analysis from the China Acute Myocardial Infarction Registry.

BackgroundThe current status of gastrointestinal prophylaxis (GIP) usage and its effects on hospitalized acute myocardial infarction (AMI) patients is not clear. We investigate the appropriateness of GIP usage and its relationship with clinical events in China.HypothesisAppropriate use of GIP is not associated with increased adverse outcomes.MethodsFrom January 2013 to September 2014, a total of 24 001 consecutive patients from 108 hospitals with AMI in China Acute Myocardial Infarction (CAMI) registry were analyzed. The appropriateness of GIP was evaluated using the current American College of Cardiology Foundation/American Heart Association (ACCF/AHA) and European Society of Cardiology (ESC) guidelines. The primary endpoint was in‐hospital gastrointestinal bleeding (GIB), while the secondary endpoints were in‐hospital and 2‐year follow‐up net adverse cardiovascular and cerebrovascular events (NACCE). Multivariate logistic regression analysis and Cox proportional hazard models were used to assess the effect of appropriate GIP.ResultsThere were 16 413 (68.38%) AMI patients co‐medicated with GIP. Among 108 involved hospitals, only 35 (32.4%) hospitals prescribed more than 50% appropriate GIP. Totally, 59.7% (14 340) AMI patients received inappropriate GIP. Inappropriate GIP use was independently associated with use of GPIIb/IIIa receptor inhibitor and primary percutaneous coronary intervention (PCI). Moreover, appropriate GIP use was associated with decreased GIB risk (OR: 0.692, 95% CI: 0.507‐0.944, P = .0202) during hospitalization, while not with increased in‐hospital and 2‐year follow‐up NACCE.ConclusionThe use of GIP is prevalent in patients with AMI in China but only 40% of hospitalized patients received appropriate GIP. Appropriate prophylactic therapy was associated with decreased GIB risk during hospitalization.

The effect of preloading statins prior to primary reperfusion on in-hospital mortality risk in a contemporary large-scale cohort of patients with ST-elevation myocardial infarction

Abstract Background The benefit of statins in secondary prevention of patients stabilized after acute coronary syndrome (ACS) has been well established. However, the benefit of preloading statins, i.e. high-intensity statins prior to reperfusion therapy remains unclear. Most previous studies included all types of ACS patients, and subgroup analysis indicated the benefit of preloading statins was only seen in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI). However, the sample size of subgroup population was relatively small and such benefit requires further validation. Objective To investigate the effect of loading dose of statins before primary reperfusion on 30-mortality in patients with STEMI. Methods We enrolled patients in China Acute Myocardial Infarction (CAMI) registry from January 2013 to September 2014. CAMI registry was a prospective multicenter registry of patients with acute acute myocardial infarction in China. Patients were divided into two groups according to statins usage: preloading group and control group. Patients in preloading group received loading does of statins before primary reperfusion and during hospitalization. Patients in control group did not receive statins during hospitalization or at discharge. Primary outcome was in-hospital mortality. Baseline characteristics, angiographic characteristics and outcome were compared between groups. Propensity score (PS) matching was used to mitigate baseline differences between groups and examine the association between preloading statins on in-hospital mortality risk. The following variables were used to establish PS matching score: age, sex, classification of hospitals, clinical presentation (heart failure at presentation, cardiac shock, cardiac arrest, Killip classification), hypertension, diabetes, prior angina, prior myocardial infarction history, prior stroke, initial treatment. Results A total of 1169 patients were enrolled in control group and 6795 in preloading group. A total of 833 patients (334 in control group and 499 in preloading group) died during hospitalization. Compared with control group, preloading group were younger, more likely to be male and present with Killip I classification. The proportion of hypertension and diabetes were higher in preloading group. After PS matching, all the variables used to generate PS score were well balanced. In the PS-matched cohort, 30-day mortality risk was 26.3% (292/1112) in the control group and 11.9% (132/1112) in the preloading group (p&amp;lt;0.0001). Conclusions The current study found preloading statins treatment prior to reperfusion therapy reduced in-hospital mortality risk in a large-scale contemporary cohort of patients with STEMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences

Geographic Variation in Process and Outcomes of Care for Patients With Acute Myocardial Infarction in China From 2001 to 2015

Variations across regions for managing acute myocardial infarction (AMI) in China are little understood. To evaluate geographic variation and its change with time in treatment process and outcomes for patients with AMI. This cross-sectional study used data from the Patient-Centered Evaluative Assessment of Cardiac Events-Retrospective AMI project in 2001, 2006, 2011, and 2015 in 153 randomly selected hospitals across China. Patients were hospitalized for AMI. Data were analyzed from October 1 to October 31, 2019. Hospitalization in 3 geographic regions (Eastern, Central, and Western) stratified according to China's official definition. Process of care measures included reperfusion therapies, aspirin, clopidogrel, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were clinically eligible without contraindications (considered as ideal candidates for treatments). Outcome measures included in-hospital mortality and 5-day mortality. Mixed models were used to assess the regional disparities and time-region interactions in those measures, adjusting for patient characteristics. In 153 hospitals across China, 27 046 patient hospitalizations for AMI were sampled. There was a significant difference across regions in process of care and the odds ratio (OR) of delivering any 1 of the 6 treatments to an ideal patient was 0.83 (95% CI, 0.76-0.91; P < .001) for the lowest region compared with the highest region. The variation between the 2 higher regions narrowed (time-by-Eastern region interaction: OR, 0.83; 95% CI, 0.76-0.91; P < .001). The region with the highest in-hospital mortality had 1.46 times greater in-hospital mortality (95% CI, 1.07-2.00; P < .001) than the lowest region and the region with the highest 5-day mortality had 1.52 times greater 5-day mortality (95% CI, 1.09-2.11; P = .04) than the lowest region. The geographic variation in mortality did not change over time. In this study, significant geographic variations in process of care and outcomes were found to persist in China; further targeted and region-based approaches to AMI management are warranted.

Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China

BackgroundIncidence, predictors, and prognostic impact of recurrent acute myocardial infarction (AMI) after initial AMI remain poorly understood. Data on recurrent AMI in China is unknown.MethodsUsing the China Patient-centred Evaluative Assessment...

Preference of individuals in the treatment strategies of acute myocardial infarction in China: a discrete choice experiment

BackgroundAcute myocardial infarction (AMI) is a significant cause of mortality and morbidity worldwide. Today, with increasing life quality and social economy, people pay much attention to the cost-effectiveness of a treatment strategy. This study investigated the preferences of individuals who would be potential caregivers or patients for AMI treatment in order to provide liable and instructive information for cardiologists and other related physicians.MethodsA discrete choice experiment was conducted among people to assess preferences for hypothetical AMI treatment scenarios characterized by the attributes of treatment method, mortality within 5 years, complication rate within 1 year, treatment duration and expense. A conditional logit regression model and latent class analysis were used to interpret the collected data systematically. The relative importance of each attribute and willingness to pay of people on the trade-offs between different treatment strategies were estimated.ResultsParticipants valued mortality within 5 years most highly (average importance: 40.9, 95%CI 0.447–0.530). Three classes of participants were identified: Class 1 placed the most importance on treatment duration, class 2 corresponded with the overall result while expense was regarded as the most important attribute in class 3. Individuals favored an intermediate treatment duration of about 10 days instead of the shortest (95% CI 1.044–1.248, P < 0.001). People’s characteristics (sex, age, marriage, education and income) affected their preferences (P < 0.01).ConclusionPeople considered a mortality rate within 5 years as the most crucial attribute in the MI treatment and preferred an intermediate treatment duration of about 10 days. Furthermore, the findings estimated the trade-offs acceptable to patients and heterogeneity in preferences for AMI treatment.

Use of intravenous magnesium sulfate among patients with acute myocardial infarction in China from 2001 to 2015: China PEACE—Retrospective AMI Study

ObjectiveIn 2001, Chinese guidelines for the care of acute myocardial infarction (AMI) included a new recommendation against the routine use of magnesium. We studied temporal trends and institutional variation in...

Association Between Medication Adherence and 1-Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in China.

BackgroundSecondary prevention after acute myocardial infarction (AMI) requires long‐term guideline‐directed medical therapy. However, the level of medication adherence, factors associated with poor adherence, and extent to which good adherence can reduce adverse events after AMI in China remain uncertain.Methods and ResultsIn 2013 to 2014, 4001 AMI patients aged ≥18 years were discharged alive from 53 hospitals across China (mean age 60.5±11.7 years; 22.7% female). Good adherence was defined as taking medications (aspirin, β‐blockers, statins, clopidogrel, or angiotensin‐converting enzyme inhibitors/angiotensin‐receptor blockers) ≥90% of the time as prescribed. Cox models assessed the association between good adherence (a time‐varying covariate) and 1‐year cardiovascular events after AMI. The most common medications were aspirin (82.2%) and statins (80.5%). There were 243 patients who were not prescribed any medications during follow‐up; 1‐year event rates were higher for these patients (25.1%, 95% CI 19.7–30.6%) versus those taking ≥1 medications (6.6%, 95% CI 5.76–7.34%). The overall rate of good adherence was 52.9%. Good adherence was associated with lower risk of 1‐year events (adjusted hazard ratio 0.61, 95% CI 0.49–0.77). The most common reason for poor adherence was belief that one's condition had improved/no longer required medication. More comorbidities and lower education level were associated with poor adherence.ConclusionsGood adherence reduced 1‐year cardiovascular event risk after AMI. About half of our cohort did not have good adherence. National efforts to improve AMI outcomes in China should focus on medication adherence and educating patients on the importance of cardiovascular medications for reducing risk of recurrent events.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01624909.

Thirty-Day Hospital Readmission After Acute Myocardial Infarction in China.

Background Readmission after acute myocardial infarction in low- and middle-income countries like China is not well characterized. Methods and Results We approached consecutive patients with acute myocardial infarction hospitalized within 24 hours of symptom onset and discharged alive from 53 geographically diverse hospitals in China. We described rates of unplanned 30-day readmission, their timing and admitting diagnoses, and fit Cox proportional hazards models to identify factors associated with readmission. Among 3387 patients, median (interquartile range) age was 61 (52-69) years, and 76.9% were men. The index median length of stay was 11 (8-14) days. Unplanned 30-day readmission occurred in 6.3% of the cohort; most readmissions (77.7%) were for cardiovascular diagnoses. Nearly half (41.9% of all-cause readmissions; 44.3% of cardiovascular readmissions) occurred within 5 days of discharge. Mini-Global Registry of Acute Coronary Events scores at admission (hazard ratio [HR], 1.15 for every 10-point increase; 95% CI, 1.05-1.25), longer length of stay (HR, 1.03; 95% CI, 1.00-1.06 for each extra day), and in-hospital recurrent angina (HR, 1.40; 95% CI, 1.04-1.89) were associated with higher unplanned all-cause readmission. Revascularization during the index hospitalization (70.2% of the cohort) was associated with lower risks of all-cause readmission (HR, 0.27; 95% CI, 0.18-0.42). In addition, left ventricular ejection fraction <0.4 (HR, 1.79; 95% CI, 1.05-3.07) and in-hospital complication (HR, 1.20; 95% CI, 1.03-1.39) were associated with higher risk of unplanned cardiovascular readmission, and ST-segment-elevation myocardial infarction (HR, 0.60; 95% CI, 0.36-0.98) was associated with lower risk of unplanned cardiovascular readmission. Sex, family income, depression, stress level, lower social support, disease-specific health status, and medications were not associated with readmission. Conclusions In China, most readmissions are for cardiovascular events, and almost half occur within 5 days of discharge. Clinical factors identify patients at higher and lower unplanned readmissions. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01624909.