Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China.
10.1097/CM9.0000000000001171
- VernacularTitle:Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China
- Author:
He ZHANG
1
;
Wen ZHENG
1
;
Shuo WU
1
;
Jing-Jing MA
1
;
Guang-Mei WANG
1
;
Yong LI
1
;
Jia-Qi ZHENG
1
;
Yuan LYU
1
;
Meng-Yang XUE
1
;
Feng XU
1
;
Jia-Li WANG
1
;
Yu-Guo CHEN
1
Author Information
1. Department of Emergency Medicine and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
- Publication Type:Journal Article
- MeSH:
China;
Female;
Humans;
Male;
Myocardial Infarction;
Percutaneous Coronary Intervention;
Risk Factors;
ST Elevation Myocardial Infarction/surgery*;
Time Factors;
Treatment Outcome
- From:
Chinese Medical Journal
2021;134(5):524-531
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.
METHODS:We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.
RESULTS:The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56-4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84-0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17-0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33-5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01-1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48-17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83-6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27-0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.
CONCLUSIONS:Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.
