Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2015 Jul 10;4(7):e001906.
doi: 10.1161/JAHA.115.001906.

National Quality Assessment of Early Clopidogrel Therapy in Chinese Patients With Acute Myocardial Infarction (AMI) in 2006 and 2011: Insights From the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective AMI Study

Lihua Zhang  1 , Nihar R Desai  2 , Jing Li  1 , Shuang Hu  1 , Qing Wang  1 , Xi Li  1 , Frederick A Masoudi  3 , John A Spertus  4 , Sudhakar V Nuti  5 , Sisi Wang  5 , Harlan M Krumholz  6 , Lixin Jiang  1 ; China PEACE Collaborative Group
Affiliations
Comparative Study

National Quality Assessment of Early Clopidogrel Therapy in Chinese Patients With Acute Myocardial Infarction (AMI) in 2006 and 2011: Insights From the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective AMI Study

Lihua Zhang et al. J Am Heart Assoc. .

Abstract

Background: Early clopidogrel administration to patients with acute myocardial infarction (AMI) has been demonstrated to improve outcomes in a large Chinese trial. However, patterns of use of clopidogrel for patients with AMI in China are unknown.

Methods and results: From a nationally representative sample of AMI patients from 2006 and 2011, we identified 11 944 eligible patients for clopidogrel therapy and measured early clopidogrel use, defined as initiation within 24 hours of hospital admission. Among the patients eligible for clopidogrel, the weighted rate of early clopidogrel therapy increased from 45.7% in 2006 to 79.8% in 2011 (P<0.001). In 2006 and 2011, there was significant variation in early clopidogrel use by region, ranging from 1.5% to 58.0% in 2006 (P<0.001) and 48.7% to 87.7% in 2011 (P<0.001). While early use of clopidogrel was uniformly high in urban hospitals in 2011 (median 89.3%; interquartile range: 80.1% to 94.5%), there was marked heterogeneity among rural hospitals (median 50.0%; interquartile range: 11.5% to 84.4%). Patients without reperfusion therapy and those admitted to rural hospitals were less likely to be treated with clopidogrel.

Conclusions: Although the use of early clopidogrel therapy in patients with AMI has increased substantially in China, there is notable wide variation across hospitals, with much less adoption in rural hospitals. Quality improvement initiatives are needed to increase consistency of early clopidogrel use for patients with AMI.

Clinical trial registration: URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01624883.

Keywords: acute myocardial infarction; clopidogrel; quality of care.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of study sample. AMI indicates acute myocardial infarction.
Figure 2
Figure 2
The proportion of early clopidogrel therapy stratified by region among patients with acute myocardial infarction. P<0.001 for changes between 2006 and 2011, P<0.001 for changes in all regions. Error bar indicates 95% CI. C/WU indicates Central/Western-urban; CR, Central-rural; ER, Eastern-rural; EU, Eastern-urban; WR, Western-rural.
Figure 3
Figure 3
The variation in early clopidogrel therapy between hospitals in rural areas and urban hospitals in 2006 and 2011. P<0.001 for the difference between rural and urban.
Figure 4
Figure 4
Factors associated with early use of clopidogrel in multivariable model. Variables with a significant association with early use of clopidogrel are shown along the vertical axis. The strength of effect is shown along the horizontal axis with the vertical solid line demarking an odds ratio (OR) of 1 (that is, no association); estimates to the right (that is, >1) are associated with greater likelihood of early clopidogrel use, while those to the left (that is, <1) indicate association with reduced likelihood of early clopidogrel use. Each square and line represents the point estimate of the effect of that variable in the model, while the line shows the 95% CI. PCI indicates percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. The World Bank. 2011. Toward a Healthy and Harmonious Life in China: Stemming the Rising Tide of Non-Communicable Diseases. Available at: http://www.worldbank.org/content/dam/Worldbank/document/NCD_report_en.pdf. Accessed January 16, 2014.
    1. Chen ZM, Jiang LX, Chen YP, Xie JX, Pan HC, Peto R, Collins R, Liu LS COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005;366:1607–1621. - PubMed
    1. Yusuf S, Zhao F, Mehta S, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without st-segment elevation. N Engl J Med. 2001;345:494–502. - PubMed
    1. Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, Claeys MJ, Cools F, Hill KA, Skene AM, McCabe CH, Braunwald E CLARITY-TIMI 28 Investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005;352:1179–1189. - PubMed
    1. China Society of Cardiology of Chinese Medical Association; Editorial Board of Chinese Journal of Cardiology. Guideline for diagnosis and treatment of patients with ST-elevation myocardial infarction. Zhonghua Xin Xue Guan Bing Za Zhi. 2010;38:675–690. - PubMed

Publication types

MeSH terms

Associated data