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.

Cardiac arrest and cardiogenic shock complicating ST-segment elevation myocardial infarction in China: A retrospective multicenter study

BackgroundData on the effect of cardiac arrest (CA), cardiogenic shock (CS), and their combination on the prognosis of Chinese patients with ST-segment elevation myocardial infarction (STEMI) are limited. The present study sought to evaluate the clinical outcomes of STEMI complicated by CA and CS, and to identify the risk factors for CA or CS. MethodsThis study included 7468 consecutive patients with STEMI in China. The patients were divided into 4 groups (CA + CS, CA only, CS only, and No CA or CS). The endpoints were 30-day all-cause death and major adverse cardiovascular events. A Cox proportional hazards regression analysis was performed. ResultsCA, CS, and their combination were noted in 332 (4.4 %), 377 (5.0 %), and 117 (1.6 %) among all patients. During the 30-day follow-up, 817 (10.9 %) all-cause deaths and 964 (12.9 %) major adverse cardiovascular events occurred, and the incidence of all-cause mortality (3.6 %, 62.3 %, 74.1 %, 83.3 %) and major adverse cardiovascular events (5.4 %, 67.1 %, 75.0 %, and 87.2 %) significantly increased in the No CA or CS, CS only, CA only, and CA + CS groups, respectively. In the multivariate Cox regression models, compared with the No CA or CS group, the CA + CS, CA, and CS-only groups were associated with an increased risk of all-cause death and major adverse cardiovascular events. Patients with CA + CS had the highest risk of all-cause death (hazard ratio [HR], 25.259 [95 % confidence interval (CI) 19.221–33.195]) and major adverse cardiovascular events (HR 19.098, 95%CI 14.797–24.648). ConclusionsCA, CS, and their combination were observed in approximately 11 % of Chinese patients with STEMI, and were associated with increased risk for 30-day mortality and major adverse cardiovascular events in Chinese patients with STEMI.

Current status of emergency medical service use in ST-segment elevation myocardial infarction in China: Findings from China Acute Myocardial Infarction (CAMI) Registry

BackgroundThe mortality rate of myocardial infarction in China has increased dramatically in the past three decades. Although emergency medical service (EMS) played a pivotal role for the management of patients with ST-segment elevation myocardial infarction (STEMI), the corresponding data in China are limited. MethodsAn observational analysis was performed in 26,305 STEMI patients, who were documented in China acute myocardial infarction (CAMI) Registry and treated in 162 hospitals from January 1st, 2013 to January 31th, 2016. We compared the differences such as demographic factors, social factors, medical history, risk factors, socioeconomic distribution and treatment strategies between EMS transport group and self-transport group. ResultsOnly 4336 patients (16.5%) were transported by EMS. Patients with symptom onset outside, out-of-hospital cardiac arrest and presented to province-level hospital were more likely to use EMS. Besides those factors, low systolic blood pressure, severe dyspnea or syncope, and high Killip class were also positively related to EMS activation. Notably, compared to self-transport, use of EMS was associated with a shorter prehospital delay (median, 180 vs. 245 min, P < 0.0001) but similar door-to-needle time (median, 45 min vs. 52 min, P = 0.1400) and door-to-balloon time (median, 105 min vs. 103 min, P = 0.1834). ConclusionsEMS care for STEMI is greatly underused in China. EMS transport is associated with shorter onset-to-door time and higher rate of reperfusion, but not substantial reduction in treatment delays or mortality rate. Targeted efforts are needed to promote EMS use when chest pain occurs and to set up a unique regionalized STEMI network focusing on integration of prehospital care procedures in China.Trial registration:ClinicalTrials.gov (NCT01874691), retrospectively registered June 11, 2013.

Trends in cognitive function before and after myocardial infarction: findings from the China Health and Retirement Longitudinal Study.

Incident stroke was associated with cognitive dysfunction after stroke and even before stroke. However, cognitive trends prior to myocardial infarction (MI) and the timeline of cognitive decline in a few years following incident MI remain unclear, especially among the Chinese population. We aimed to evaluate whether MI was associated with cognitive change both before and after MI in China. This cohort study included 11,287 participants without baseline heart problems or stroke from the China Health and Retirement Longitudinal Study. The exposure was self-reported MI. The outcomes were scores of cognitive functions in five domains, which reflected abilities of episodic memory, visuospatial abilities, orientation, attention and calculation, and global cognition as a summary measure. A Linear mixed model was constructed to explore cognitive function before and after incident MI among the MI participants and the cognitive trends of participants free of MI. During the 7-year follow-up, 421 individuals [3.7% of 11,287, mean (SD) age, 60.0 (9.0) years; 59.1% female] experienced MI events. The cognitive scores of participants of both the MI group and the control group without MI declined gradually as time went by. The annual decline rate of the MI group before incident MI was similar to that of the control group during the whole follow-up period. Incident MI was not associated with acute cognitive decline in all five cognitive domains. Moreover, MI did not accelerate the cognitive decline rate after MI compared with the pre-MI cognitive trends. The decline rate of cognitive function after MI was similar to the rate before MI. Different from stroke, participants who had an MI did not show steeper cognitive decline before MI. MI was not associated with acute cognitive decline and accelerated decline in several years after MI. Future studies are needed to learn the mechanisms behind the different patterns of cognitive decline between MI and stroke.

Meta-analysis of risk factors for posttraumatic stress disorder in myocardial infarction.

The aim of this study was to identify the risk factors for posttraumatic stress disorder in patients with myocardial infarction. Cohort, case-control, and cross-sectional studies on posttraumatic stress disorder (PTSD) in patients with myocardial infarction were searched from PubMed, Embase, Cochrane Library, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and Technology Journal database. The Newcastle-Ottawa Quality Assessment Scale was used to score the quality of the included literature in the cohort and case-control studies, and the cross-sectional studies were scored using the American Agency for Health Care Quality and Research cross-sectional study quality evaluation criteria. The literature was screened independently by 2 researchers, and if there was no consensus, the inclusion was decided by a third party. The extraction content included first author, publication year, sample size, PTSD assessment tool, PTSD assessment time, PTSD incidence, influencing factors, and study type. Meta-analysis of data was performed using Stata17.0 software. Ten studies were included, including 2 cohort studies, 7 cross-sectional studies, and 1 case-control study, with a total sample size of 2371 patients, including 26 influencing factors. The results of meta-analysis showed that the prevalence of PTSD in patients with myocardial infarction was 21.2%. Statistically significant influencing factors were gender (odd ratio [OR] = 3.124), neuroticism score (OR = 2.069), and age (OR = 0.913). The prevalence of PTSD in patients with myocardial infarction in China is higher than that in other countries. Female and neurotic personality are risk factors for developing PTSD in patients with myocardial infarction, and old age is protective factor for developing PTSD in patients with myocardial infarction. Targeted measures should be taken to prevent and reduce the occurrence and development of PTSD in patients with myocardial infarction in the future.

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.

Ambient PM2.5 and acute incidence of myocardial infarction in China: a case-crossover study and health impact assessment

Background and purpose: Evidence investigating the association between ambient fine particulate matters (PM2.5) and acute incidence of myocardial infarction in developing countries is limited. This study aims to investigate linear and nonlinear patterns for the association between PM2.5 and acute incidence of myocardial infarction based on multicounty registry dataset and evaluate the reduction of premature myocardial infarction incidence under different pollution control objectives in China. Methods: Thirty-six thousand six hundred and seventy-nine registered myocardial infarction incidence cases from 15 Chinese counties from January 1, 2013, to December 31, 2017, were obtained. We adopted a time-stratified case-crossover design with conditional logistic regression models. Results: With a 10 μg/m3 increase in PM2.5 exposure, there was an increase of 0.98% (95% CI: 0.40%–1.57%) in acute incidence risk of myocardial infarction. The corresponding values for males and individuals aged over 74 years were 1.58% (95% CI: 0.82%–2.35%) and 1.19% (95% CI: 0.35%–2.05%) respectively, indicating higher risks than other groups. The nonlinear concentration–response curve indicated a steeper slope under daily exposure below 50 μg/m3 and the marginal avoided premature morbidity became larger under the current air quality standard. Conclusions: The robust findings from this study may suggest the necessity for a continuous reduction of PM2.5 exposure concentration from the perspectives of public health.

Practice of reperfusion in patients with ST-segment elevation myocardial infarction in China: findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project.

Reperfusion therapy is fundamental for ST-segment elevation myocardial infarction (STEMI). However, the details of contemporary practice and factors associated with reperfusion therapy in China are largely unknown. Therefore, this study aimed to explore reperfusion practice and its associated factors among hospitalized patients with STEMI in China. Patients with STEMI who were admitted to 159 tertiary hospitals from 30 provinces in China were included in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project from November 2014 to December 2019. The associations of the characteristics of patients and hospitals with reperfusion were examined using hierarchical logistic regression. The associations between therapies and in-hospital major adverse cardiovascular events were examined with a mixed effects Cox regression model. Among the 59,447 patients, 37,485 (63.1%) underwent reperfusion, including 4556 (7.7%) receiving fibrinolysis and 32,929 (55.4%) receiving primary percutaneous coronary intervention (PCI). The reperfusion rate varied across geographical regions (48.0%-73.5%). The overall rate increased from 60.0% to 69.7% from 2014 to 2019, mainly due to an increase in primary PCI within 12 h of symptom onset. Timely PCI, but not fibrinolysis alone, was associated with a decreased risk of in-hospital major adverse cardiovascular events compared with no reperfusion, with an adjusted hazard ratio (95% confidence interval) of 0.64 (0.54,0.76) for primary PCI at <12 h, 0.53 (0.37,0.74) for primary PCI at 12 to 24 h, 0.46 (0.25,0.82) for the pharmaco-invasive strategy, and 0.79 (0.54,1.15) for fibrinolysis alone. Nationwide quality improvement initiatives should be strengthened to increase the reperfusion rate and reduce inequality in China. www.ClinicalTrials.gov , NCT02306616.

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.

The Peripandemic Impact of the First Wave of the COVID-19 Pandemic on Management and Prognosis of ST-Segment Elevation Myocardial Infarction in China.

Rapid reperfusion of ST-segment elevation myocardial infarction (STEMI) has been challenging during the coronavirus disease 2019 (COVID-19) outbreak. Whether and to what degree there will be a residual impact when the COVID-19 pandemic has passed is unclear. This nationwide retrospective study was based on electronic records of STEMI patients registered in the Chinese Cardiovascular Association Database. We analyzed 141,375 STEMI patients (including 4871 patients in Hubei province, where 80% of COVID-19 cases in China occurred in 2019-2020) during the pre-outbreak (23 October 2019-22 January 2020), outbreak (23 January 2020-22 April 2020), and post-outbreak (23 April 2020-22 July 2020) periods. In the post-outbreak period in Hubei province, the increased in-hospital mortality dropped to become insignificant (adjusted odds ratio compared to the pre-outbreak level (aOR) 1.40, [95% confidential interval (CI): 0.97-2.03]) and was lower than that in the outbreak period (1.62 [1.09-2.41]). The decreased odds of primary percutaneous coronary intervention (PCI) (0.73 [0.55-0.96]) and timely reperfusion (0.74 [0.62-0.88]) persisted, although they were substantially improved compared to the outbreak period (aOR of primary PCI: 0.23 [0.18-0.30] and timely reperfusion: 0.43 [0.35-0.53]). The residual impact of COVID-19 on STEMI in the post-outbreak period in non-Hubei provinces was insignificant. Residual pandemic impacts on STEMI management persisted after the first wave of the COVID-19 outbreak in Hubei province, the earliest and hardest hit area in China.

Quality of healthcare and admission rates for acute cardiac events during COVID-19 pandemic: a retrospective cohort study on ST-segment-elevation myocardial infarction in China

ObjectiveTo evaluate changes in admission rates for and quality of healthcare of ST-segment-elevation myocardial infarction (STEMI) during the period of the COVID-19 outbreak and postoutbreak.MethodsWe conducted a retrospective study among...

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.

Performance of Management Strategies With Class I Recommendations Among Patients Hospitalized With ST-Segment Elevation Myocardial Infarction in China

Despite advances in the treatment of ST-segment elevation myocardial infarction (STEMI), little is known about how this evolving knowledge is applied in current clinical practice in China. To evaluate hospital performance and temporal trends in the management of STEMI. This study used data from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project, a nationwide quality improvement registry, in collaboration with the American Heart Association and the Chinese Society of Cardiology. Participants included patients with STEMI admitted to 143 tertiary hospitals across China from November 2014 to July 2019, and data were analyzed from November 2020 to December 2021. Levels, hospital-level variations, and trends for utilization rates of the 9 management strategies with Class I recommendations in Chinese and US guidelines. A total of 57 560 hospitalizations with STEMI were included. Overall, 20.0% of patients received all the care according to the 9 guideline-recommended strategies. The performance rate of quality measures was low for reperfusion therapy (61.0%, 35 115/57 560 patients), β-blocker at discharge (68.3%, 37 750/55 285 patients), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge (55.1%, 2524/4578 patients), and smoking cessation counseling (36.5%, 9586/26 265 patients) among those who were eligible. Of 25 563 patients who underwent primary percutaneous coronary intervention (PCI), 66.8% underwent this procedure within 90 minutes of hospital arrival. Of 1128 patients who underwent fibrinolysis therapy, 253 (22.4%) underwent this treatment within 30 minutes of hospital arrival. Measures with high performance rates included receipt of dual antiplatelet therapy within 24 hours (95.5%, 54 263/56 848 patients) and at discharge (91.8%, 51 452/56 019 patients) and receipt of statin at discharge (93.0%, 52 214/56 141 patients) for those eligible. There was significant variation between hospitals in all-or-none score (ranging from 0 to 61.9%) and performance of individual measures. The quality of care improved during the study period, especially for reperfusion therapy, primary PCI within the first 90 minutes of hospital arrival, and smoking cessation counseling. The quality of care for patients hospitalized with STEMI does not meet guideline-recommended strategies in China, with only 1 in 5 patients receiving all the care according to the 9 guideline-recommended strategies. Large disparities in the quality of care exist across hospitals.

Current Status and Hospital-Level Differences in Care and Outcomes of Patients With Acute Non-ST-Segment Elevation Myocardial Infarction in China: Insights From China Acute Myocardial Infarction Registry.

BackgroundWith the growing burden of non-ST-elevation myocardial infarction (NSTEMI), developing countries face great challenges in providing equitable treatment nationwide. However, little is known about hospital-level disparities in the quality of NSTEMI care in China. We aimed to investigate the variations in NSTEMI care and patient outcomes across the three hospital levels (province-, prefecture- and county-level, with decreasing scale) in China.MethodsData were derived from the China Acute Myocardial Infarction Registry on patients with NSTEMI consecutively registered between January 2013 and November 2016 from 31 provinces and municipalities throughout mainland China. Patients were categorized according to the hospital level they were admitted to. Multilevel generalized mixed models were fitted to examine the relationship between the hospital level and in-hospital mortality risk.ResultsIn total, 8,054 patients with NSTEMI were included (province-level: 1,698 patients; prefecture-level: 5,240 patients; county-level: 1,116 patients). Patients in the prefecture- and county-level hospitals were older, more likely to be female, and presented worse cardiac function than those in the province-level hospitals (P <0.05). Compared with the province-level hospitals, the rate of invasive strategies was significantly lower in the prefecture- and county-level hospitals (65.3, 43.3, and 15.4%, respectively, P <0.001). Invasive strategies were performed within the guideline-recommended timeframe in 25.4, 9.7, and 1.7% of very-high-risk patients, and 16.4, 7.4, and 2.4% of high-risk patients in province-, prefecture- and county-level hospitals, respectively (both P <0.001). The use of dual antiplatelet therapy in the county-level hospitals (87.2%) remained inadequate compared to the province- (94.5%, P <0.001) and prefecture-level hospitals (94.5%, P <0.001). There was an incremental trend of in-hospital mortality from province- to prefecture- to county-level hospitals (3.0, 4.4, and 6.9%, respectively, P-trend <0.001). After stepwise adjustment for patient characteristics, presentation, hospital facilities and in-hospital treatments, the hospital-level gap in mortality risk gradually narrowed and lost statistical significance in the fully adjusted model [Odds ratio: province-level vs. prefecture-level: 1.23 (0.73–2.05), P = 0.441; province-level vs. county-level: 1.61 (0.80–3.26), P = 0.182; P-trend = 0.246].ConclusionsThere were significant variations in NSTEMI presentation and treatment patterns across the three hospital levels in China, which may largely explain the hospital-level disparity in in-hospital mortality. Quality improvement initiatives are warranted, especially among lower-level hospitals.

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.

Peripandemic Impact of the First Wave of COVID-19 Pandemic on Management and Prognosis of ST-Segment Elevation Myocardial Infarction in China

Peripandemic Impact of the First Wave of COVID-19 Pandemic on Management and Prognosis of ST-Segment Elevation Myocardial Infarction in China

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 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

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&lt;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.

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.