Long-Term Prognosis of Different Reperfusion Strategies for ST-Segment Elevation Myocardial Infarction in Chinese County-Level Hospitals: Insight from China Acute Myocardial Infarction Registry.

Chao WU; Qiong Yu Zhang; Ling LI; Xu Xia Zhang; Yong Chen Cai; Jin Gang Yang; Hai Yan XU; Yan Yan Zhao; Yang Wang; Wei LI; Chen Jin; Xiao Jin Gao; Yue Jin Yang; Shu Bin Qiao

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Long-Term Prognosis of Different Reperfusion Strategies for ST-Segment Elevation Myocardial Infarction in Chinese County-Level Hospitals: Insight from China Acute Myocardial Infarction Registry.

Author: Chao WU ¹ ; Qiong Yu ZHANG ² ; Ling LI ³ ; Xu Xia ZHANG ⁴ ; Yong Chen CAI ⁵ ; Jin Gang YANG ¹ ; Hai Yan XU ¹ ; Yan Yan ZHAO ³ ; Yang WANG ³ ; Wei LI ³ ; Chen JIN ¹ ; Xiao Jin GAO ¹ ; Yue Jin YANG ¹ ; Shu Bin QIAO ¹
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1. Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing 100037, China.
2. Hypertension Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing 100037, China.
3. Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing 100037, China.
4. Department of Cardiology, Tonghua Central Hospital, Tonghua 134000, Jilin, China.
5. Department of Cardiology, The First Hospital of Suihua, Suihua 152054, Heilongjiang, China.
Publication Type:Journal Article
Keywords: Acute myocardial infarction; Outcome; Reperfusion therapy; Rural
MeSH: Humans; ST Elevation Myocardial Infarction/therapy*; Percutaneous Coronary Intervention; East Asian People; Treatment Outcome; Myocardial Reperfusion; Myocardial Infarction; Registries; Hospitals
From: Biomedical and Environmental Sciences 2023;36(9):826-836
CountryChina
Language:English
Abstract: OBJECTIVE:To evaluate the long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) treated with different reperfusion strategies in Chinese county-level hospitals.
METHODS:A total of 2,514 patients with STEMI from 32 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014. The success of fibrinolysis was assessed according to indirect measures of vascular recanalization. The primary outcome was 2-year mortality.
RESULTS:Reperfusion therapy was used in 1,080 patients (42.9%): fibrinolysis ( n= 664, 61.5%) and primary percutaneous coronary intervention (PCI) ( n= 416, 38.5%). The most common reason for missing reperfusion therapy was a prehospital delay > 12 h (43%). Fibrinolysis [14.5%, hazard ratio ( HR): 0.59, 95% confidence interval ( CI) 0.44-0.80] and primary PCI (6.8%, HR= 0.32, 95% CI: 0.22-0.48) were associated with lower 2-year mortality than those with no reperfusion (28.5%). Among fibrinolysis-treated patients, 510 (76.8%) achieved successful clinical reperfusion; only 17.0% of those with failed fibrinolysis underwent rescue PCI. There was no difference in 2-year mortality between successful fibrinolysis and primary PCI (8.8% vs. 6.8%, HR = 1.53, 95% CI: 0.85-2.73). Failed fibrinolysis predicted a similar mortality (33.1%) to no reperfusion (33.1% vs. 28.5%, HR= 1.30, 95% CI: 0.93-1.81).
CONCLUSION:In Chinese county-level hospitals, only approximately 2/5 of patients with STEMI underwent reperfusion therapy, largely due to prehospital delay. Approximately 30% of patients with failed fibrinolysis and no reperfusion therapy did not survive at 2 years. Quality improvement initiativesare warranted, especially in public health education and fast referral for mechanical revascularization in cases of failed fibrinolysis.