Percutaneous coronary intervention in patients with acute coronary syndrome in Chinese Military Hospitals, 2011-2014: a retrospective observational study of a national registry

Abstract

Objectives: Interventional treatment of patients with acute coronary syndrome (ACS) is surging dramatically in China in recent years, whereas nationwide assessments of the quality of percutaneous coronary intervention (PCI) procedural performance and outcomes are scarce. We aimed to provide an updated and real-world overview of the performance of PCI in patients with ACS since 2011 in China after the China PEACE study from 2001 to 2011.

Methods: In this cross-sectional study, data were extracted from the National Registry of Cardiovascular Intervention in Military Hospitals database to create a national sample of 144 659 patients with ACS undergoing PCI at 117 military hospitals in all regions of China from calendar years 2011-2014. Patient characteristics, procedural performance, PCI outcomes and adverse events and temporal changes were analysed.

Results: During 2011-2014, patients with ACS undergoing PCI increased dramatically. Small numbers of high-volume hospitals performed the majority of PCI procedures. However, only half of these patients were adequately covered and proportions for the use of assisted devices and novel medications were relatively small. Radial artery access was still increasing with time. Primary PCIs were performed on 45.4% ST-segment elevation myocardial infarction patients with PCI procedures. 3.8% lesion vessels involve left main artery. Implanted stents, the overall complications and in-hospital mortality were decreasing remarkably.

Conclusions: In Chinese military hospitals, interventional resources were limited with great regional disparities, there are still gaps to be filled to better serve patients with ACS. Our findings can serve as an indispensable supplement to a more comprehensive understanding of the practice of contemporary cardiac intervention in China.

Keywords: acute coronary syndrome; percutaneous coronary intervention; quality of care; trending.

Figure 1

Overall and regional distributions of percutaneous coronary intervention (PCI)-capable military hospitals and PCI procedures performed. Military hospitals were divided by their annual PCI volume with a threshold of 400 cases per year (A), as well as further by geographical regions (C); the overall PCI procedures performed during 2011–2014 were also grouped by annual PCI volumes of hospitals (B) and by regions (D). Northern China include North China, Northwest China and Northeast China, Southern China include South China, East China, Central China and Southwest China.

Figure 2

Adjusted in-hospital mortality for patients with acute coronary syndrome undergoing percutaneous coronary intervention. Adjusted OR of 1 shows no difference from year 2011. We included 1 43 063 patients (30 202 in 2011, 34 304 in 2012, 39 206 in 2013 and 39 351 in 2014).