Infarction In China Research Articles

Managing acute myocardial infarction in China.

Managing acute myocardial infarction in China.

Analysis of Effect of Schisandra in the Treatment of Myocardial Infarction Based on Three-Mode Gene Ontology Network.

Schisandra chinensis is a commonly used traditional Chinese medicine, which has been widely used in the treatment of acute myocardial infarction in China. However, it has been difficult to systematically clarify the major pharmacological effect of Schisandra, due to its multi-component complex mechanism. In order to solve this problem, a comprehensive network analysis method was established based-on “component–gene ontology–effect” interactions. Through the network analysis, reduction of cardiac preload and myocardial contractility was shown to be the major effect of Schisandra components, which was further experimentally validated. In addition, the expression of NCOR2 and NFAT in myocyte were experimentally confirmed to be associated with Schisandra in the treatment of AMI, which may be responsible for the preservation effect of myocardial contractility. In conclusion, the three-mode gene ontology network can be an effective network analysis workflow to evaluate the pharmacological effects of a multi-drug complex system.

Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction in China

Despite a rapid increase in percutaneous coronary intervention (PCI) procedures in China, little is known about patient-reported health status before and after PCI in patients without acute myocardial infarction (AMI). To describe self-perceived angina-specific health status prior to PCI and 1 year after the procedure in patients without AMI in China. The China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Prospective Study of PCI was a population-based, multicenter cohort study of a consecutive sample of 1611 patients without AMI undergoing elective PCI. Participants were enrolled from 40 hospitals in 18 provinces in China from December 2012 to August 2014. Participants were eligible if they underwent PCI for stable and unstable angina and did not have AMI. Participants were excluded if they died in hospital, withdrew from follow-up, or had missing data on self-reported health status at baseline or at 1 year after PCI. The date of the analysis was September 15, 2018. Percutaneous coronary intervention for ischemic heart disease. Angina frequency and angina-related quality of life were assessed with the Seattle Angina Questionnaire (SAQ) immediately prior to PCI and 1 year after the procedure. Either (1) an increase in the SAQ Angina Frequency score of 10 or more points or (2) an increase in the SAQ Quality-of-Life score of 10 or more points was considered to represent clinically significant improvement. Of 1611 patients, 520 (32.3%) were women; mean (SD) age was 61.3 (9.8) years. Among these patients, 443 (27.5%) had stable coronary artery disease and 1168 (72.5%) had unstable angina. One hundred fourteen of 443 patients undergoing PCI for stable coronary artery disease (25.7%) and 175 of 1168 undergoing PCI for unstable angina (15.0%) had no reported angina symptoms at the time of the procedure (SAQ Angina Frequency score = 100). Moreover, 18% of all patients (290) had minimal angina symptoms (SAQ Angina Frequency score >90) and, thus, no potential for substantial clinical improvement. Patients with smaller clinical improvements in angina symptom burden at 1 year following PCI had significantly higher baseline SAQ scores for all scales than patients with greater clinical improvement, but generally similar sociodemographic and procedural characteristics. In this study, 25.7% of patients undergoing PCI for stable coronary artery disease had no reported angina symptoms at the time of the procedure. Patients with smaller clinical improvements in angina symptom burden had higher baseline SAQ scores, which highlights the importance of ascertaining impairment from angina among patients without AMI prior to performing PCI.

Factors Associated With Return to Work After Acute Myocardial Infarction in China

ImportanceReturn to work is an important indicator of recovery after acute myocardial infarction. Little is known, however, about the rate of returning to work within the year after an acute myocardial infarction in China, as well as the factors associated with returning to work after an acute myocardial infarction.ObjectivesTo determine the rate of return to work within 12 months after acute myocardial infarction, classify the reasons why patients did not return to work, and identify patient factors associated with returning to work.Design, Setting, and ParticipantsThis prospective cohort study, conducted in 53 hospitals across 21 provinces in China, identified 1566 patients who were employed at the time of the index acute myocardial infarction hospitalization and participating in the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction. Data collected included patients’ baseline characteristics; employment status at 12 months after acute myocardial infarction; and, for those who were not employed at 12 months, potential reasons for not returning to work. A logistic regression model was fitted to identify factors associated with returning to work at 12 months. Data were collected from January 1, 2013, through July 17, 2014, and statistical analysis was conducted from August 9, 2016, to August 15, 2018.Main Outcomes and MeasuresReturn to work, defined as rejoining the workforce within 12 months after discharge from hospitalization for the index acute myocardial infarction.ResultsOf 1566 patients (130 women and 1436 men; mean [SD] age, 52.2 [9.7] years), 875 patients (55.9%; 95% CI, 53.4%-58.3%) returned to work by 12 months after acute myocardial infarction. Among the 691 patients who did not return to work, 287 (41.5%) were unable to work and/or preferred not to work because of acute myocardial infarction and 131 (19.0%) retired early owing to the acute myocardial infarction. Female sex (relative risk, 0.65; 95% CI, 0.41-0.88), a history of smoking (relative risk, 0.82; 95% CI, 0.65-0.98), and in-hospital complications during the index acute myocardial infarction (relative risk, 0.96; 95% CI, 0.93-0.99) were associated with a lower likelihood of returning to work.Conclusions and RelevanceAlmost half of the previously employed Chinese patients did not return to work within 12 months after acute myocardial infarction. Female sex, history of smoking, and in-hospital complications were associated with a lower likelihood of returning to work.Trial RegistrationClinicalTrials.gov Identifier: NCT01624909

Exploring the effect of weekend admissions to hospital on health outcomes of inpatients with acute myocardial infarction in Shanxi, China: a longitudinal study

BackgroundPrevious studies have identified a so-called weekend effect—ie, higher mortality for inpatients admitted to hospital on a weekend than on a weekday. However, the effect for acute myocardial infarction-related admissions to hospital and other health outcomes are unclear. We therefore aimed to investigate the weekend effect on adverse outcomes in inpatients with acute myocardial infarction in China. MethodsWe did a longitudinal study of 31 tertiary hospitals in Shanxi, China. We included inpatients with acute myocardial infarction who were aged 18 years or more. These eligible participants were identified from the front pages of inpatients' medical records, and we classified them into two groups: ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). The primary measures were the associations between weekend admission and in-hospital mortality, hospital-acquired infection, and extended length of stay (defined as length of stay >75 percentile). We used multivariate logistic regression models with clustered robust variance estimator to determine these associations. FindingsBetween Sept 1, 2013, and Oct 31, 2017, a total of 42 671 inpatients with acute myocardial infarction were identified (28 731 inpatients in the STEMI group and 13 940 in the NSTEMI group), and 11 294 (26·5%) inpatients were admitted to hospitals during the weekend. The crude in-hospital mortality was 1·83% (weekend 2·20% vs weekday 1·69%; p<0·0001), hospital-acquired infection was 4·99% (weekend 5·29% vs weekday 4·88%; p<0·0001), and extended length of stay was 23·58% (weekend 26·23% vs weekday 22·63%; p<0·0001). After controlling for demographics, comorbidities, and hospital characteristics, patients admitted to hospitals on weekends were significantly more likely to have an extended length of stay for both STEMI (odds ratio [OR] 1·22, 95% CI 1·13–1·30]) and NSTEMI (1·19, 1·10–1·28) groups than those admitted to hospitals on weekdays. There were no significant differences in in-hospital mortality (STEMI group: OR 1·10 [95% CI 0·87–1·39]; NSTEMI group: 1·08 [0·84–1·41]) and hospital-acquired infection (STEMI group: 0·95 [0·79–1·15]; NSTEMI group: 0·92 [0·63–1·32]) between weekend and weekday admissions. InterpretationFor patients admitted to hospital for acute myocardial infarction, weekend admission is associated with a higher risk of extended length of stay than weekday admission, but not for in-hospital mortality and hospital-acquired infection. More efforts are needed to reduce the disparities of extended length of stay and improve patient safety and quality of care for weekend admissions. FundingNational Natural Science Foundation of China Grant (71473099).

GW29-e1000 Reperfusion therapy and antithrombotic treatments in patients 75 years and older with ST-segment elevation myocardial infarction in China: findings from the CCC-ACS Project

With population aging and the extension of life expectancy, the proportion of patients ≥ 75 years of age with ST-segment elevation myocardial infarction (STEMI) is expected to increase. As these elderly patients are at high risk of both ischemia and bleeding, giving the appropriate treatment to

Sex differences in health outcomes at one year following acute myocardial infarction: A report from the China Patient-Centered Evaluative Assessment of Cardiac Events prospective acute myocardial infarction study.

We examined sex differences in long-term health outcomes following acute myocardial infarction in China, including mortality, major adverse cardiac events and health status (symptoms, functioning, quality of life). A total of 3415 acute myocardial infarction patients (23.2% women) aged ⩾18 years were enrolled across 10 geographic regions in China (2012-2014) in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) study. Clinical data was abstracted from medical records. Generic (Euro-Quality of Life Scale) and disease-specific (Seattle Angina Questionnaire) health status was obtained through interviews at baseline and one year. At one year, women with acute myocardial infarction had a higher risk of death from all causes ( p<0.001), but had similar rates of major adverse cardiac events ( p=0.2). Women had lower mean generic (Euro-Quality of Life Scale utility index score: 0.90±0.13 vs 0.94±0.11) and disease specific health scores indicating poorer functioning (Seattle Angina Questionnaire summary score: 75.3±11.4 vs 78.4±9.7) and higher rates of daily/weekly angina (Seattle Angina Questionnaire angina frequency score ⩽60 vs >60: 9.1% vs 4.7%; all p<0.001). In multivariable analysis, there was a significant association between female sex and mortality (β=0.45, standard error=0.21, p=0.03) but not for major adverse cardiac events (β=-0.02, standard error=0.14, p=0.89). The association between female sex and worse generic health status persisted (β=-0.02, standard error=0.01, p=0.003), but was no longer significant between sexes for disease-specific health status (β=-0.82, standard error=0.58, p=0.154) or daily/weekly angina (odds ratio=1.39; 95% confidence interval 0.88-2.21). Women in China have higher crude rates of all-cause/cardiovascular death versus men, as well as worse generic/disease specific health status at one-year post-acute myocardial infarction. The association between female sex and worse generic health status persisted following adjustment.

Time to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study.

AimsFew contemporary studies have reported the time between acute myocardial infarction (AMI) symptoms onset and hospital arrival, associated factors, and patient perceptions of AMI symptoms and care seeking. We sought to study these issues using data from China, where AMI hospitalizations are increasing.Methods and resultsWe used data from the China PEACE prospective AMI study of 53 hospitals across 21 provinces in China. Patients were interviewed during index hospitalization for information of symptom onset, and perceived barriers to accessing care. Regression analyses were conducted to explore factors associated with the time between symptom onset and hospital arrival. The final sample included 3434 patients (mean age 61 years). The median time from symptom onset to hospital arrival was 4 h (interquartile range 2–7.5 h). While 94% of patients reported chest pain or chest discomfort, only 43% perceived symptoms as heart-related. In multivariable analyses, time to hospital arrival was longer by 14% and 39% for patients failing to recognize symptoms as cardiac and those with rural medical insurance, respectively (both P < 0.001). Compared with patients with household income over 100 000 RMB, those with income of 10 000–50 000 RMB, and <10 000 RMB had 16% and 23% longer times, respectively (both P = 0.03).ConclusionWe reported an average time to hospital arrival of 4 h for AMI in China, with longer time associated with rural medical insurance, failing to recognize symptoms as cardiac, and low household income. Strategies to improve the timeliness of presentation may be essential to improving outcomes for AMI in China.Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT01624909.

Geographic Variations in In‐Hospital Mortality and Use of Percutaneous Coronary Intervention Following Acute Myocardial Infarction in China: A Nationwide Cross‐Sectional Analysis

BackgroundPrevalence of acute myocardial infarction (AMI) is increasing in China, and AMI has become a major cause of mortality; however, information is very limited about the nationwide geographic and hospital variation in in‐hospital mortality (IHM) and the use of percutaneous coronary intervention (PCI) after AMI.Methods and ResultsFrom the Nationwide Hospital Discharge Database of China, we identified 242 866 adult admissions with AMI in 2015 from 1055 tertiary hospitals. We used multivariable logistic regressions to analyze the associations between geographic or hospital characteristics with IHM or PCI use. The national IHM rate was 4.71% (95% confidence interval, 4.62–4.79%). There was a greater risk of mortality in the Northeast (odds ratio [OR]: 1.86), West (OR: 1.73), South (OR: 1.32), and North (OR: 1.14) regions than in the East region of China. Non–teaching hospitals (OR: 1.18) and tertiary level B hospitals (OR: 1.06) were associated with higher IHM rates. The national PCI use rate was 45.3% (95% confidence interval, 45.1–45.5%). Compared with the East region of China, PCI use was lower in the Northeast (OR: 0.50), West (OR: 0.64), North (OR: 0.84), and South (OR: 0.88) regions. Non–teaching hospitals (OR: 0.83) and tertiary level B hospitals (OR: 0.55) were also associated with lower usage rates. There was a significant negative correlation between IHM and PCI use (r=−0.955), and IHM rates for patients with and without PCI both differed by geographic regions.ConclusionsThere were significant differences in IHM and PCI use among China's tertiary hospitals, linked to both geographic and hospital characteristics. More targeted intervention at national and regional levels is needed to improve access to effective health technologies and, eventually, outcomes following AMI.

Trends study of diet consulting for discharged patients with acute myocardial infarction in China from 2001 to 2011

Objective: To describe trends in diet consulting at discharge for patients with acute myocardial infarction (AMI) in China from 2001-2011. Methods: A representative sample of patients in China admitted to hospital for AMI was created from a two-stage sampling approach; profiles for patients with AMI were retrospectively abstracted through their medical records.The study described the overall trends in diet consulting for patients with AMI in China, the rates of diet consulting among patients with hypertension, diabetes, and hyperlipidemia, and the variation in diet consulting across different regions. Results: We sampled 162 hospitals and included 16 100 patients with AMI in total.The weighted rates of diet consulting at AMI discharge in China was 16.5%, 28.8%, and 40.8% in 2001, 2006 and 2011, respectively (P for trend <0.001). The rates and trends among patients with hypertension, diabetes, and hyperlipidemia were similar to those among all patients with AMI (hypertension: 16.4%, 31.4%, and 41.1% in 2001, 2006 and 2011, respectively; diabetes: 18.2%, 32.2%, and 42.8%; hyperlipidemia: 18.6%, 31.4%, and 41.5%; all P for trend <0.001). The rates has not changed much for those in central rural region over the decade (19.2%, 19.4%, and 22.8% in 2001, 2006 and 2011, respectively; P for trend=0.09); meanwhile, the rates of diet consulting in other four regions increased over years (all P for trend<0.001). Conclusions: From 2001 to 2011, the rates of diet consulting at discharge for patients with AMI has increased in China; however, there are still substantial rooms for improvement, especially for central rural region.Dietitian could work with clinician and be involved in diet consulting for AMI at discharge in order to improve prognosis for patients with AMI.

Effect of aspirin on the pharmacokinetics and absorption of panax notoginseng saponins

BackgroundPanax notoginseng saponins, a traditional Chinese medicine extraction, and aspirin are both widely used to treat cerebral infarction in China. Good results in clinical practice have been achieved, when Panax notoginseng saponins was taken together with aspirin. MethodsTo investigate the interaction of the two drugs in vivo, the concentration of notoginsenoside R1, ginsenoside Rg1, Rb1, Re and Rd. in blood were simultaneously measured by UPLC/MS/MS. Sample preparation was carried out by the protein precipitation technique with an internal standard saikosaponin A standard. The separation of six components was achieved by using an ACQUITY UPLC ®BEH C18 column (1.7μm 2.1×100mm) by gradient elution using water (containing 0.2% formic acid) and acetonitrile (containing 0.2% formic acid) as the mobile phase at a flow rate of 0.2mL/min. The pharmacokinetic parameters were determined using non-compartmental analysis. The transport of notoginsenoside R1, ginsenoside Rg1, Rb1, Re and Rd. in MDCK -MDR1 cell monolayer was also used to verify the conclusion of pharmacokinetic drug-drug interaction and study the mechanism of drug interaction. ResultsThe concentrations of the five components increased in a certain extent when the two drugs administered together in rats. The values of apparent permeability coefficients were significantly increased when the two drugs were used together. Aspirin and salicylic acid could destroy the tight junction protein and open the intercellular space to increase the absorption of Panax notoginseng saponins. ConclusionPharmacokinetic drug-drug interaction in vivo existed between Panax notoginseng saponins and aspirin. The drug-drug interaction mainly occurred in the process of absorption.

In-hospital mortality after acute myocardial infarction in China: a nationwide cross-sectional analysis

BackgroundThe prevalence of acute myocardial infarction (AMI) has increased in China within the past few decades and is now a major cause of mortality. Percutaneous coronary intervention (PCI) is an effective treatment for AMI. We aimed to investigate how geographical and hospital characteristics affect in-hospital mortality and PCI use for AMI admissions in tertiary hospitals. MethodsWe extracted data from the Nationwide Hospital Discharge Database from China's National Center for Health Statistics. Adjusted odds ratios (aORs) with 95% CI from multivariable logistic regressions were reported as associations between geographical variation or hospital characteristics and in-hospital mortality or PCI use, controlling for demographics and comorbidity scores. FindingsWe identified 242866 adult admissions with AMI as primary diagnosis in 2015 from 1055 tertiary hospitals. The nationwide in-hospital mortality rate of AMI was 4·7% and differed significantly by geographic regions: 6·44% in northeast China; 5·84% in west China, 4·50% in south China, 3·77% in east China, and 3·60% in north China. Compared with eastern China, a high risk of in-hospital mortality was found in northeast China (aOR 1·86; 95%CI 1·75–1·98), west China (1·74; 1·62–1·86), south China (1·32; 1·24–1·40), and north China (1·14; 1·06–1·22). Hospital characteristics associated with the highest mortality were non-teaching hospitals (1·18; 1·12–1·24) and tertiary B hospitals (1·06; 1·01–1·11). The nationwide rate of PCI use was 45·3%. Compared with eastern China, PCI use was low in northeast China (0·49; 0·47–0·50), west China (0·63; 0·62–0·65), north China (0·83; 0·81–0·85), and south China (0·88; 0·86–0·91). Other factors that contributed to lowering the rate of PCI use were non-teaching hospitals (0·84; 0·81–0·865) and tertiary B hospitals (0·55; 0·53–0·56). InterpretationAmong China's tertiary hospitals, substantial disparities of in-hospital mortality and PCI use be attributable to geographical and hospital characteristics. More efforts are needed to reduce disparities and improve access to effective health technology. FundingNational Natural Science Foundation of China Grant (81671786). The funder had no role in the conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation or approval of the Abstract.

Urban-Rural Comparisons in Hospital Admission, Treatments, and Outcomes for ST-Segment-Elevation Myocardial Infarction in China From 2001 to 2011: A Retrospective Analysis From the China PEACE Study (Patient-Centered Evaluative Assessment of Cardiac Events).

In response to urban-rural disparities in healthcare resources, China recently launched a healthcare reform with a focus on improving rural care during the past decade. However, nationally representative studies comparing medical care and patient outcomes between urban and rural areas in China during this period are not available. We created a nationally representative sample of patients in China admitted for ST-segment-elevation myocardial infarction in 2001, 2006, and 2011, using a 2-stage random sampling design in 2 urban and 3 rural strata. In China, evidence-based treatments were provided less often in 2001 in rural hospitals, which had lower volume and less availability of advanced cardiac facilities. However, these differences diminished by 2011 for reperfusion therapy (54% in urban versus 57% in rural; P=0.1) and reversed for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (66% versus 68%; P=0.04) and early β-blockers (56% versus 60%; P=0.01). The risk-adjusted rate of in-hospital death or withdrawal from treatment was not significantly different between urban and rural hospitals in any study year, with an adjusted odds ratio of 1.13 (0.77-1.65) in 2001, 0.99 (0.77-1.27) in 2006, and 0.94 (0.74-1.19) in 2011. Although urban-rural disparities in evidence-based treatment for myocardial infarction in China have largely been eliminated, substantial gaps in quality of care persist in both settings. In addition, urban hospitals providing more resource-intensive care did not achieve better outcomes. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

Air Pollution and Hospitalization for Acute Myocardial Infarction in China

There is growing interest in the association between ambient air pollution and acute myocardial infarction (AMI). The objective of this study was to explore the association in 14 Chinese cities using a time-stratified case-crossover design. We identified 80,787 hospital admissions for AMI between January 1, 2014 and December 31, 2015 from electronic hospitalization summary reports. Conditional logistic regression was used to estimate the percent changes with 95% confidence intervals (CIs) in AMI admissions in relation to an interquartile range increase in ambient air pollutant concentrations. All analyzed air pollutants, with the exception of ozone, were positively associated with daily AMI admissions on lag2 and lag3 days. An interquartile range increase in particulate matter <10 µm in aerodynamic diameter, sulfur dioxide, nitrogen dioxide, and carbon monoxide concentrations on lag2 day was significantly associated with a 0.8% (95% CI 0.1%, 1.6%), 2.0% (95% CI 1.2%, 2.9%), 2.2% (95% CI 1.4%, 3.1%), and 1.1% (95% CI 0.4%, 1.8%) increase in AMI admissions, respectively. We also observed a significant association in relation to ozone on lag4 day (percent change: 1.3%; 95% CI 0.2%, 2.4%). Subgroup analyses indicated no effect modification of risk by age (≥65 years and <65 years) or gender. In conclusion, this is the first multicity study in China, or even in other developing countries, to report the short-term effects of air pollution on AMI morbidity. Our findings contribute to the limited scientific data on the effects of ambient air pollution on AMI in developing countries.

Prevalence of cardiovascular medication on secondary prevention after myocardial infarction in China between 1995-2015: A systematic review and meta-analysis.

BackgroundMyocardial Infarction (MI) has become a major cause of morbidity and mortality in China, but little is known about the prevalence of guideline-recommended cardiovascular medications after MI events over the last two decades. This systematic review and meta-analysis aims to summarize cardiovascular medication use between 1995–2015 and to assess factors in associated with the trends in cardiovascular medications.MethodA systematic search was conducted in four databases (Pubmed, Embase, CENTRAL, and CNKI) to obtain observational studies published between 1995 and 2015, reporting on the use of cardiovascular medications in China. Risk of bias of individual studies was appraised and selected studies were pooled for estimated prevalence of cardiovascular medication. Prevalence of cardiovascular medication use for 1995 and 2015 was estimated by random effects meta-regression model.ResultsFrom 13,940 identified publications, 35 studies, comprising 28,000 patients, were included. The pooled prevalence for aspirin, beta-blockers, statins, ACE-Inhibitors, ACE-Inhibitor/ARBs and nitrates was 92% [95% confidence interval (CI): 0.89–0.95], 63% (95% CI: 0.57–0.69), 72% (95% CI: 0.60–0.82), 49% (95% CI: 0.41–0.57), 59% (95% CI: 0.48–0.69) and 79% (95% CI: 0.74–0.91), respectively. A significant increase in beta-blocker and statin use and a decrease of nitrate use was observed over time. The estimated prevalence of beta-blockers, statins, and nitrates was 78%, 91.1%, and 59.3% in 2015, compared to 32%, 17% and 96% in 1995, respectively.ConclusionCardiovascular medication use after MI is far from optimal in Chinese patients, even though the prevalence of use increased over the period 1995–2015. With a rapidly increasing number of MI patients in China, a comprehensive strategy on secondary prevention is warranted.Systematic review registrationPROSPERO (CRD42015025246)

Seasonal variations of temperature-related mortality burden from cardiovascular disease and myocardial infarction in China

Incidence rate of cardiovascular disease (CVD) has significant seasonal trend, being higher in winter. However, the extent to which the seasonal variation of CVD deaths was caused by temperature remains unclear. We obtained daily data on temperature and CVD and myocardial infarction (MI) mortality from nine Chinese mega-cities during 2007–2013. Distributed lag non-linear models were applied to assess the city-specific temperature-related daily excess deaths across lag 0–21 days, using the minimum-mortality temperature as reference. Then, estimates of excess deaths in four seasons were separately aggregated from the daily series, and its ratio to the corresponding total deaths produced seasonal attributable fraction (AF). In total, 1,079,622 CVD and 201,897 MI deaths were recorded in the nine Chinese cities. Significant and non-linear associations between temperature and mortality were observed, with a total of 195,516 CVD and 50,658 MI deaths attributable to non-optimum temperatures. 103,439 (95% empirical CI: 54,475–141,537) CVD and 24,613 (5891–36,279) MI deaths related to non-optimum temperature occurred in winter, compared with 15,923 (1436–28,853) and 4946 (-325-9016) in summer. Temperature-related AFs were higher among MI than CVD, with AFs of 42% (9–62%) and 35% (19–48%) in winter, and 13% (-1-23%) and 8% (1–14%) in summer, respectively. This study may have important implications for developing effective targeted intervention measures on CVD events.

Clinical characteristics and improvement of the guideline-based management of acute myocardial infarction in China: a national retrospective analysis

ObjectiveThis study is to document the clinical characteristics and improvement in management of acute myocardial infarction (AMI) in Chinese population.ResultsThis study included 64,654 patients (23,805 patients in 2011, 40,849 patients in 2013), of which STEMI and NSTEMI account for 85.09% and 14.91%, respectively. From 2011 to 2013, significant improvement has been achieved in the recanalization rate of PCI (96.01% vs. 98.63%, P < 0.001) and in-hospital deaths (4.52% vs. 3.55%, P = 0.038). Although the time of door-to-balloon and the duration of PCI were satisfactorily controlled within 90min and 60min, respectively, the onset-to-FMC time (≈3.5h) and door-to-thrombolysis time (≈1.1h) limited the efficiency of management. The total cost of medical care showed no increase from 2011 to 2013, but the patient's paid Portion decreased from 20.33% to 13.96%.Materials and MethodsThe AMI patients admitted in the general hospitals in 2011 and 2013 were retrospectively analyzed according to the data reported to the Single Disease Quality Control Information Systemissued by Chinese Hospital Association.ConclusionCompared to the Western countries, STEMI accounted for a larger portion of AMI, and the AMI management in China basically meets the standards of the quality control of guidelines. With improvement of management, there was no increase in the total medical cost, while the patient's paid portion was actually reduced. In future, improvement of transportation strategy and the public medical education are recommended to shorten the onset-to-FMC time to further improve the outcome of AMI patients.

Effect of Panax notoginseng saponins on the pharmacokinetics of aspirin in rats.

Aspirin (ASA) is widely used to treat fever, pain, inflammation and cerebral infarction in clinic. Panax Notoginseng Saponins (PNS) is the extracts of Panax Notoginseng (PN)-a traditional Chinese medicine extensively used in cardiovascular diseases. Panax notoginseng saponins and ASA are both widely used to treat cerebral infarction in China. Good results in clinical practice have been achieved when the two drugs were taken together. To investigate the effect of PNS on ASA in vivo, the concentrations of salicylic acid (SA) in blood were measured after oral administration of ASA or ASA combined with PNS by UPLC-MS/MS. Sample preparation was carried out by the protein precipitation technique with an internal Saikosaponin A standard. The separation of two components was achieved by using an ACQUITY UPLC ®BEH C18 Column (1.7μm 2.1×100mm) by gradient elution using water (containing 0.2% formic acid) and acetonitrile (containing 0.2% formic acid) as the mobile phase at a flow rate of 0.2mL/min. The pharmacokinetic parameters were determined by using non-compartmental analysis. The results suggested that drug-drug interaction in vivo existed between PNS and ASA. The concentration of the SA was increasing when the two drugs were administered together. The transport of ASA and SA in MDCK -MDR1 cell monolayer was used to verify this conclusion. The values of apparent permeability coefficients (Papp) were significantly increased when the two drugs were used together. This result suggested PNS could increase the gastrointestinal tract absorption of ASA and SA. These findings provide more insight for wise use of two drugs to treat or prevent cardiovascular diseases.

Mortality due to acute myocardial infarction in China from 1987 to 2014: Secular trends and age-period-cohort effects

BackgroundIn contrast with most developed countries, mortality from acute myocardial infarction (AMI) continues to rise in China. We examined secular trends and age, period, and cohort effects in mortality from AMI in China from 1987 to 2014. MethodsData on deaths from AMI between 1987 and 2014 were obtained from the Chinese Health Statistics Annual Report (1987–2001) and the Chinese Health Statistics Yearbook (2003–2015). We then conducted an age-period-cohort analysis using the intrinsic estimator approach. ResultsThere was an upward trend in AMI mortality in both urban and rural populations that accelerated from 2004 onwards. AMI mortality increased 5.6-fold from 1987 to 2014. The net age effect on AMI mortality increased exponentially. AMI mortality risk in the 80–84years of age bracket was 220.15 and 190.70 times higher than in the 15–19years of age bracket in urban and rural populations, respectively. There was a V-shaped trend in the net period effect between 1999 and 2009. Meanwhile, although there was a global reduction in the cohort effect in urban and rural AMI mortality, we found a modest increase among urban populations born between 1975 and 1989 and rural populations born between 1990 and 1999. ConclusionThe changes in exposure to lifestyle-related risk factors and triggers such as air pollution have contributed to the increase in AMI mortality in China over recent decades. The sharp increase in AMI mortality since 2004 is primarily attributable to population aging and the rise in AMI deaths among younger generations.

Acceleration of Chest Pain Center Construction and Improvements for the Treatment of Acute Myocardial Infarction in China

At present cardiovascular disease prevention and control in China is in crisis. The level of acute coronary syndrome (ACS) treatment and the establishment of modern treatment guidelines in China lag behind those other developed countries. The Chinese Medical Association, the Chinese Association of Cardiovascular Health and the Cardiovascular Health Alliance have developed a program to accelerate the construction of China Chest Pain Centers(CCPC)and stringent certification requirements. The program includes: (1) establishing demonstration centers in 60 cities throughout China; (2) development of guidelines for the construction and certification of regional and primary chest pain centers; (3) expansion of the number of training instructors and certification experts; (4) expansion of the scale and frequency of training; (5) quality improvements to the overall training system, and (6) quality improvements to key assessment indicators (KPI) information systems and related initiatives. We propose the establishment of 40 chest pain center demonstration bases through the provision of guidance and training to 2500 hospitals toward the goals of promotion, construction and certi cation of 1000 chest pain centers in China between 2016 and 2018.